Evaluating rural-urban disparities in glioblastoma treatment, determining if differences in care and outcomes exist, and identifying trends.

Glioblastoma is the most prevalent primary brain tumor in adults, with poor prognosis and significant morbidity. While disparities in cancer outcomes between rural and urban populations are documented, few studies have examined this specifically in glioblastoma. Our study compared outcomes in Vermont, one of the most rural states in the U.S., to national trends.

We conducted a retrospective analysis of SEER data (2001–2022) to assess rural–urban differences in treatment and survival, classifying residence with RUCC codes. Analyses focused on treatment modalities and survival outcomes. Parallel analyses using the University of Vermont Medical Center Registry (2011-2022) allowed comparison of regional outcomes with SEER findings.

National data confirmed persistent disparities in prior studies, with urban patients demonstrating longer median overall survival (urban 9 months vs rural 7 months, p < 0.0001). Age, sex, tumor location, and surgical rates were similar across groups, but rural patients were less racially diverse, had lower median household income, and were more likely to receive radiation and chemotherapy. In Vermont, however, survival differences were minimal, with rural patients showing slightly better outcomes (rural 10.7 months vs urban 9.6 months, p = 0.64). Rural Vermonters more often underwent surgical resection, while urban patients more frequently received radiation and chemotherapy. Of note, Vermont patients overall had higher rates of chemotherapy use (71%) compared to national averages (59%).

This exploratory analysis suggests by this data suggests that while rural patients with glioblastoma have poorer survival nationally, there may be better outcomes in Vermont, where all patients have some aspects of their care at an academic hospital/cancer center. We need to consider how rurality impacts health and access for patients with primary brain tumors, and how hospital systems may approach their rural patient populations.