The Impact of Social Determinants on Receipt of Adjuvant Radiation Nationally Following Atypical Meningioma Surgery

Abstract Purpose: We aimed to identify socioeconomic gaps in the administration of adjuvant radiotherapy for patients with atypical meningioma and secondarily to determine differences in survival between patients receiving radiation and those not receiving radiation at 12 and 60 months. Methods: The National Cancer Database was queried for patients receiving atypical meningioma surgery between 2004 and 2019. Statistical analyses were performed to assess the association between receipt of adjuvant radiation and social determinants. Secondarily, KM curves were used to compare overall patient survival between those that received radiation and those that did not. Results: Adjuvant radiation was less likely to be administered to patients over 65 (95% CI =0.53- 22 0.77) and more likely to be administered to males (95% CI =1.07-1.38). Compared to the Southern USA, patients were more likely to receive radiotherapy in the Northeastern (95% CI 24 =1.40–2.05), Midwestern (95% CI =1.06-1.54), and Western parts of the USA (95% 25 CI =1.31-2.00). Patients residing furthest from their facility were less likely to receive radiation (95% CI =0.65-0.98). Insured patients were more likely to receive radiation (p = 0.048) than uninsured patients. On multivariate analysis, no differences were found between racial groups regarding adjuvant radiation. For patients unstratified, radiation was shown to improve survival at 12 and 60 months. Conclusion: Disparities exist in the administration of adjuvant radiotherapy for atypical meningioma. Patients over 65, women, those residing in the southern USA, those living further from their facilities and uninsured patients are less likely to receive radiation than their counterparts.