Factors associated with longer survival among older medicare patients after diagnosis of supratentorial primary brain malignancies: a retrospective cohort study

ABSTRACT

Objectives

Despite recent advances, the prognosis for primary malignant brain tumors (PMBTs) remains poor. Some commonly prescribed medications may exhibit anti-tumor properties in various cancers, and neurodegenerative diseases may activate pathways that counteract gliomagenesis. Our study is focused on determining if there is a correlation between the use of metformin, beta-blockers, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), or the presence of Parkinson’s disease (PD), and the survival rates following a diagnosis of a PMBT.

Methods

This analysis of the 100% Texas Medicare Database identified patients aged 66+ years diagnosed with a supratentorial PMBT from 2014–2017. Cox proportional hazards regression was employed to analyze survival following diagnosis and associations of survival with surgical intervention, radiation, PD diagnosis, and prescription of metformin, beta-blockers, ACEIs, or ARBs.

Results

There were 1,943 patients who met study criteria, and the median age was 74 years. When medication utilization was stratified by none, pre-diagnosis only, post-diagnosis only, or both pre- and post-diagnosis (continuous), continuous utilization of metformin, beta-blockers, ACEIs, or ARBs was associated with prolonged survival compared to no utilization (hazard ratio [HR]:0.45, 95% CI:0.33–0.62; HR:0.71. 95% CI:0.59–0.86; HR:0.59, 95% CI:0.48–0.72; and HR:0.45, 95% CI:0.35–0.58 respectively). PD was also associated with longer survival (HR:0.59–0.63 across the four models).

Discussion

Our study suggests that metformin, beta-blockers, ACEIs, ARBs, and comorbid PD are associated with a survival benefit among geriatric Medicare patients with supratentorial PMBTs.

KEYWORDS:

• Primary malignant brain tumor
• glioblastoma
• survival
• medicare database
• geriatric
• neurosurgery
• neuro-oncology

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors were involved with study design and conception. A.N., J.S., and C.N. reviewed the literature, and A.N., J.S., B.D., C.N., and Y.K wrote the manuscript main text. A.N., J.S., B.D., and Y.K. prepared the figures and tables. B.D. and Y.K. were responsible for data acquisition and statistical analysis. All authors critically reviewed and interpreted the results. All authors reviewed and proofread the manuscript. E.W., J.H., and Y.K were responsible for oversight of the study. All authors approve of its submission and are accountable for their contributions.

Data availability statement

The Texas Medicare Database is not readily available for public use. Access was provided to B.D. and Y.K.

Supplemental material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/01616412.2024.2323335.

Additional information

Funding

This study was funded by the Cancer Prevention and Research Institute of Texas via grant RP210130, and the Helen Vosburg McCrillus Plummer and Robert Edward Lee Plummer, Jr. endowed Chair fund in Neurosurgery.