Sociodemographic Barriers to Successful Implementation of Optune in Glioblastoma Multiforme Patients

Objectives: Tumor-treating fields (TTFields), or Optune, is a therapy that utilizes electrical fields to stagnate tumor growth in patients with glioblastoma multiforme (GBM). This retrospective review of a single institution's experience identifies sociodemographic hurdles to patient compliance, initiation, and continuation with TTFields. We aimed to isolate patients who were not offered TTFields and those who terminated treatment so that we could hypothesize ways to overcome common barriers for our future patients. Methods: Socioeconomic and demographic information between 2015 and 2022 was collected from 178 GBM patient records and analyzed using R. Device usage information was provided by Novocure. Kaplan-Meier survival estimates and reasons for termination were recorded. Results: Of the 178 patients, 96 were offered TTFields. Among the 82 patients not offered Optune, 66% did not receive the treatment due to their poor KPS. The insurance provider (P=0.86) did not play a role in Optune being offered. Of the 112 patients with spousal support, 65 started treatment (58%) as compared with 47% (29/62) of those without spousal support starting treatment. For those that started TTFields, disease progression was the primary reason for terminating device usage (26%) followed by discomfort from wearing the device (10%). Patient outcomes showed an elevated median survival in patients who used the device (21 mo vs. 9 mo). Conclusion: Although TTFields is effective, we identified several obstacles to initiating and sustaining treatment. Future work into finding initiatives to help patients overcome these barriers is imperative to increasing its use in all patient populations.