Does Geography Impact Neurosurgical Care? A Single Institution Study of Australians With High-Grade Glioma.

Abstract

High-grade gliomas (HGGs) are incurable central nervous system malignancies. In Australia, neuro-oncological surgical centres are concentrated to metropolitan locations, increasing travel distance for rural patients. This study aims to investigate the relationship between geography and timely care, access to gold standard therapy, and survival for HGG patients at our Victorian institution. We retrospectively reviewed medical records of patients diagnosed with HGG at our institution from 2017 to 2023. Geography was measured through location of residence (urban vs. rural) and distance travelled to the surgical center. Outcomes were split by disease grade and compared across geographical cohorts. Of 314 included patients, 29.6% resided rurally and the median travel distance was 27.8 km. Age, comorbidity score, disease grade, and sex did not differ across geographical measures, but socioeconomic status did (P < 0.001). No differences in time to surgery, chemotherapy, and radiation nor odds of experiencing adjuvant therapy were observed based on geography. However, those travelling more than 28 km with grade 4 disease were more likely to have complete surgical excision (odds ratio [OR]: 4.82, confidence interval [CI]: 2.12-11.4, P < 0.001) than those closer to the center. Survival did not differ between rural and urban cohorts (hazard ratio [HR]: 1.30, CI: 0.98-1.74, P = 0.071), nor far or short travelling populations (HR: 1.22, CI: 0.85-1.77, P = 0.30). This is the first Australian study of geography's impact in a HGG cohort. Despite high volume neuro-oncology services treating a geographically diverse population, the centralization of care does not compromise on service provision or outcomes.