Disparities in Care in Adult Glioblastoma: A Comprehensive Narrative Review.

Abstract

Glioblastoma is the most common and aggressive primary malignant brain tumor in adults. While tumor biology plays a central role in disease progression, a substantial and growing body of evidence implicates structural and social determinants of health in mediating access to care and influencing clinical outcomes. This narrative review critically examines disparities in glioblastoma care across multiple axes, including socioeconomic status, race and ethnicity, geographic location, healthcare infrastructure, and institutional characteristics. Findings are synthesized from epidemiologic studies, health systems research, and qualitative investigations to elucidate the mechanisms by which inequities in diagnosis, treatment access, clinical trial participation, and end-of-life care arise and persist. Disparities are evident not only in low-resource settings and low-/middle-income countries, but also within high-income nations and universal healthcare systems, where sociodemographic variables continue to influence the likelihood of receiving guideline-concordant care. Emerging interventions, such as patient navigation programs, regionalization strategies, inclusive clinical trial frameworks, and policy-level reforms, offer actionable pathways to mitigate these inequities. Our findings underscore that disparities in glioblastoma care are largely systemically driven and modifiable, necessitating coordinated, equity-oriented strategies across the continuum of neuro-oncologic care.