P15.22.B UNMASKING SOCIOECONOMIC INEQUITIES IN GLIOBLASTOMA CARE: A SYSTEMATIC REVIEW OF BARRIERS TO PALLIATIVE AND SUPPORTIVE SERVICES IN ASIA

Abstract BACKGROUND Glioblastoma (GBM), the most aggressive primary brain tumor, imposes severe physical, emotional, and financial burdens, especially in low- and middle-income countries (LMICs), where socioeconomic disparities restrict access to palliative and supportive care services that are essential for quality of life (QoL). This systematic review presents the first comprehensive synthesis of GBM care barriers in Asia, focusing on structural inequities and their impact on symptom management, psychosocial support, and end-of-life care. MATERIAL AND METHODS A systematic search of PubMed, Cochrane, Scopus, ScienceDirect, and Wiley Online Library (2000 to 2025) identified studies on GBM treatment access, socioeconomic factors, and outcomes in Asia and LMICs. Inclusion criteria targeted studies addressing income, education, insurance status, treatment adherence, and access to palliative care. Twenty-six studies were included and appraised using the CHEERS checklist and Newcastle-Ottawa Scale. A thematic synthesis was conducted to identify common barriers, systemic gaps, and implications for QoL and supportive care. RESULTS Socioeconomic disparities consistently increased symptom burden and delayed access to supportive care, reducing QoL. In the Philippines, 62 percent of patients discontinued adjuvant therapy due to financial constraints, with a median survival of 7.6 months and limited access to pain relief or psychological support. Uninsured patients had shorter survival (8.8 versus 15.2 months), exacerbating emotional distress and caregiver strain. In Taiwan, universal health coverage improved therapy access, but supportive care gaps persisted. Systemic barriers such as a significant neurosurgeon shortage in South Asia and limited availability of genomic diagnostics (only 9.4 percent of LMIC centers offered next-generation sequencing) hindered timely, personalized care. Financial toxicity frequently led to treatment abandonment and unmanaged end-of-life symptoms. CONCLUSION Socioeconomic inequities in Asia and LMICs critically limit access to palliative and supportive services for GBM patients, increasing distress and reducing QoL. Policy solutions should include expansion of publicly funded therapies, enhancement of neurosurgical and diagnostic capacity, and implementation of universal health coverage with strong financial protection to support equitable, patient-centered GBM care.