Rural medical disparities in multimodal glioblastoma treatment

Glioblastoma continues to have a poor prognosis, although recent advancements in multimodal treatments have gradually improved outcomes. However, treatment options have become increasingly complex and highly specialized. In rural areas, patients often travel long distances for treatments such as bevacizumab (BEV) administration, which may hinder treatment adherence and potentially lead to poorer outcomes. This study analyzed the impact of commuting distance on survival using clinical data from the Kyushu Neuro-Oncology Study Group. We measured the commuting distances of 564 patients with glioblastoma who were initially treated at 11 participating institutions between 2010 and 2023. Patients were categorized into nearby and remote groups using a threshold of 20 km, and their overall survival (OS) was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model, incorporating additional potential prognostic factors. In the overall cohort, there was no significant difference in OS between the nearby and remote groups (median OS: 19.2 vs. 18.3 months). However, among the 452 patients who underwent second-line treatment for recurrence, OS was significantly longer in the nearby group (median OS: 18.7 vs. 16.8 months). Univariate analysis revealed that commuting distance (P = 0.037), age, extent of resection, and performance status (PS) were all significant prognostic factors. Multivariate analysis demonstrated that commuting distance was an independent prognostic factor (P = 0.009). These results were validated through propensity score matching, which analyzed 148 patients in each group (median OS: 19.3 vs. 16.4 months). Our findings suggest that commuting distance is associated with prognosis in glioblastoma patients who require second-line treatment. To address this issue, it is necessary to establish an environment that enables the smooth and continuous delivery of multimodal treatment, particularly in rural areas.

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Publication Details

Journal
Scientific Reports
Published
2026-06-25
DOI
https://doi.org/10.1038/s41598-026-48867-8
Primary Topic
Glioma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

Rural medical disparities in multimodal glioblastoma treatment

Motohiro Morioka, Takayuki Matsuo, Junkoh Yamamoto, Nayuta Higa et al.
Scientific Reports
Glioma Diagnosis and Treatment
article

Rural medical disparities in multimodal glioblastoma treatment

Motohiro Morioka, Takayuki Matsuo, Junkoh Yamamoto, Nayuta Higa, Yasutomo Momii, Kohei Suzuki, Hidenobu Yoshitake, Daisuke Kuga, Yukiko Nakahara, Akitake Mukasa, Tadashi Hamasaki, Kenta Ujifuku, Naoki Shinojima, Tetsuya Negoto, Shinji Yamashita, Yoshiteru Nakano, Hideki Nagamine, Kiyohiko Sakata, Koji Yoshimoto, Yutaka Fujioka, Hirotaka Fudaba, Yoshiko Okita, Hokama Yohei, Minoru Fujiki, Nobuhiro Hata, Ryosuke Hanaya, Namikawa Hiroki, Takeshi Hiu, Kiyotaka Saito, Ryusuke Hatae, Shohei Nagasaka, Hirotaka Inoue, Toshiyuki Enomoto, Aya Hashimoto, Hajime Yonezawa, Kenji Fujimoto, Tatsuya Abe, Hiroshi Abe, Fumitaka Matusmoto, Ito Hiroshi, Kyushu Neuro-Oncology Study Group
article en

Abstract

Glioblastoma continues to have a poor prognosis, although recent advancements in multimodal treatments have gradually improved outcomes. However, treatment options have become increasingly complex and highly specialized. In rural areas, patients often travel long distances for treatments such as bevacizumab (BEV) administration, which may hinder treatment adherence and potentially lead to poorer outcomes. This study analyzed the impact of commuting distance on survival using clinical data from the Kyushu Neuro-Oncology Study Group. We measured the commuting distances of 564 patients with glioblastoma who were initially treated at 11 participating institutions between 2010 and 2023. Patients were categorized into nearby and remote groups using a threshold of 20 km, and their overall survival (OS) was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model, incorporating additional potential prognostic factors. In the overall cohort, there was no significant difference in OS between the nearby and remote groups (median OS: 19.2 vs. 18.3 months). However, among the 452 patients who underwent second-line treatment for recurrence, OS was significantly longer in the nearby group (median OS: 18.7 vs. 16.8 months). Univariate analysis revealed that commuting distance (P = 0.037), age, extent of resection, and performance status (PS) were all significant prognostic factors. Multivariate analysis demonstrated that commuting distance was an independent prognostic factor (P = 0.009). These results were validated through propensity score matching, which analyzed 148 patients in each group (median OS: 19.3 vs. 16.4 months). Our findings suggest that commuting distance is associated with prognosis in glioblastoma patients who require second-line treatment. To address this issue, it is necessary to establish an environment that enables the smooth and continuous delivery of multimodal treatment, particularly in rural areas.

Scientific Reports
Kurume University (JP), Kagoshima University (JP), University of Miyazaki (JP), Kyushu University (JP), Saga University (JP), University of Occupational and Environmental Health Japan (JP), Oita University (JP), Fukuoka University (JP), University of the Ryukyus (JP), Nagasaki University (JP), Kumamoto University (JP)
No poverty
Openalex Percentile: Top 8%
Glioma Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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