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This section discusses current research on the link between socioeconomic status and brain cancer as well as global trends in brain cancer.

Socioeconomic Status and Brain Cancer in the US

Many research studies have shown a connection between socioeconomic status and brain cancer. All studies indicate, in various ways, that the lower your socioeconomic status, the worse your outcomes. Below is a summary of some of the biggest studies from the past five years: 


In a 2021 study, patients in the lowest socioeconomic status quintile had lower chances of receiving chemotherapy and radiation. 


A 2020 study showed that parents with higher education levels and a mother with higher income was found to be associated with an increased risk of brain tumors in children. This may be due to having more accessibility to diagnostic tests, communicating better with health professionals, or being more persistent in efforts to find an explanation for their child’s symptoms. 


Another 2020 study found that patients with lower socioeconomic status and educational level had significantly shorter survival times than patients with higher socioeconomic status and educational level. This could be attributed to higher socioeconomic status patients having more surgery and radiation compared to lower socioeconomic patients. Another hypothesis is that higher socioeconomic status patients can have better access to high quality care and therefore more and earlier surgical and radiation treatments. These results were replicated in studies from 2014, 2017, 2019, again in 2020, and yet again in 2020.


In a 2018 study, patients who had Medicaid or other government insurance, were not insured, and lived farther away from the treatment facility had higher odds of getting radiation >35 days after the surgical resection. Patients who lived in higher income areas had higher odds of getting radiation <35 days after the surgical resection. The same paper found that there is a survival benefit in starting radiation <35 days after the surgical resection.

In a different 2018 study, survivors with lower income levels and lower education levels were also found to be at an increased risk of not having follow-up care conversations with their providers. This might be because income and education level are intrinsically linked, and also because the cost of follow-up care may serve as a deterrent for lower income individuals.

Global Trends in Brain Cancer

There are trends between brain cancer occurrence and mortality rates and the Human Development Index in countries across the world. A 2020 study found that in countries with high levels of Human Development Index (HDI), brain cancer tends to have a higher occurrence and mortality rate. This is because of several factors such as advanced early screening for detection, accessible primary healthcare, accurate healthcare services, and a reliable registry system. However, it has also been argued that higher brain tumor occurrence rates in countries with higher HDIs can be explained by the presence of environmental hazards and occupational exposures to radiation and radioactive sources. 


The countries with the highest occurrence of brain cancer are Australia, North America, and Europe. A 2014 study using an Australian dataset found that there are no significant socio-demographic distinctions observed when comparing survivorship for patients with brain tumors. The same study also found that patients who survived for more than 2 years were more likely to have higher socioeconomic status. In a different 2014 study conducted in Canada, patients in lower socioeconomic quintiles had lower survival rates than those in higher quintiles. A 2020 study in Italy noticed that adult patients with lower socioeconomic status have an increased risk of developing brain cancer, and an Italian 2020 study found that overall survival was associated with higher income.


The countries with the highest mortality rates are China, the United States, India, Brazil, and Russia. While Western countries have had a decline in occurrence and mortality rates of brain cancer, some developing countries in Europe and Asia are still experiencing increases in these rates.

Clinical Trials And Brain Cancer: A Worldwide Perspective

Clinical trials for brain cancer offer a glimmer of hope for many patients. However, the dynamics surrounding participation in these trials vary significantly between countries. In the United States, financial constraints drive many individuals to explore experimental treatments, while in other countries, clinical trials are a last resort for those with limited access to approved therapies. This dichotomy raises ethical questions and highlights social inequalities in the pursuit of life-saving interventions.

The US healthcare system does not make it easy to bring care to people, because it is driven by insurance companies. This is especially difficult for individuals of lower socioeconomic status with limited coverage plans, or who rely on Medicaid. On top of that, there are not a lot of approved treatments for brain cancer, and insurance companies will not pay for unapproved treatments or for drugs that treat other cancers. But there is a large population of people who cannot afford even these approved therapies; clinical trials are their only means of getting care, even if it is experimental. Seeing a physician at all is yet another financial obstacle patients have to overcome. Many neuro-oncologist specialists work within specific, premium networks that are not available to everybody. 

A 2020 study found that the majority of patients with brain tumors are unable to return to work. The diagnosis therefore doesn’t only have an impact on the individual, but on their family as well. The financial toxicity that patients face is overwhelming. Brain cancer has a high financial cost – for the neurosurgery itself, and treatments like chemotherapy and radiation. A 2022 survey showed that many patients take out loans to pay for care and can’t even afford to stay at a hotel. Some don’t have enough money for food or a taxi to the hospital.  

At the NIH, for example, patients can receive excellent care without any cost or need for insurance. Some patients have referrals from around the country, or the world, to come to the NIH to receive care. During COVID, the NIH has focused on not making patients come to them, but instead traveling to the patients. They have started decentralized clinical trials so that the patient can stay with their families and won’t have to pay for travel, food, and childcare. At the NIH, they are mindful of the challenges that families face and include coverage for travel for the patient and a companion. They also provide resources like hotels, food, and a stipend. This makes their treatments accessible. But many centers do not have this resource, and for some people, even this coverage is not enough. Some patients need childcare or another necessity that the NIH doesn’t cover. 

This financial barrier creates a unique and dystopian situation where participation in clinical trials is not a choice made out of a search for alternative treatments, but rather out of desperation and necessity. Despite the risks involved, individuals see these trials as a lifeline, offering an opportunity for treatment—any treatment—that is otherwise financially out of reach. Organizations like the NIH have created opportunities to overcome socioeconomic inequality and provide patients with innovative treatments. 

Contrasting the system in the United States, certain countries present a different landscape for clinical trials. Take Costa Rica and Ecuador, for instance, where education is more accessible, and healthcare is often free and/or easily attainable. In these countries, individuals typically turn to clinical trials when they have exhausted all approved treatment options and find themselves in a terminal state. Here, the motivation stems from a willingness to try something experimental, driven by the belief that it might not only benefit them, but also contribute to medical advancements for others. This could cause a patient’s assessment of their quality of life to change. They are fighting their disease while helping someone else in later phases of clinical trials, which can make them very positive. 

The implications of participating in clinical trials in countries with accessible healthcare where patients have exhausted all other options raise complex questions. Is it ethically justifiable for individuals to try experimental treatments that are not fully developed, potentially risking their health for the sake of medical progress? On the other hand, the social inequality within the United States adds another layer to this ethical dilemma. Clinical trials, which are typically perceived as a last resort, become a stark reminder of the disparities in access to healthcare. While some can choose to participate for the potential benefits, others are compelled to join due to a lack of alternatives. 

The ethical implications of these differences highlight the need for a global conversation on healthcare access and the role of clinical trials in addressing the complexities of brain cancer treatment. The U.S. healthcare system currently forces the economically disadvantaged into drug experimentation, with the alternative often being death. This benefits only the privileged, as even if treatments are approved, those with lower incomes can't afford insurance covering them. As we navigate these challenges, it is crucial to advocate for equitable healthcare solutions that bridge the gap and ensure that hope is not a privilege but a universal right.

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Socioeconomic differences in the risk of childhood central nervous system tumors in Denmark: a nationwide register‑based case–control study (2020)

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Socioeconomic Disparities in Brain Metastasis Survival and
Treatment: A Population-Based Study (2021)

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Socioeconomic Status Predicts Survival In Patients With Newly Diagnosed Glioblastoma (2014)

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Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States (2020)

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Long-term incidence of glioma in Olmsted County, Minnesota, and disparities in postglioma survival rate: a population-based study (2020)

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The effect of socioeconomic status on gross total resection, radiation therapy and overall survival in patients with gliomas (2017)

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The relationship between cancer survivors’ socioeconomic status and reports of follow-up care discussions with providers (2018)

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The association between incidence and mortality of brain cancer and human development index (HDI): an ecological study (2020)

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Global incidence of malignant brain and other central nervous system tumors by histology, 2003–2007 (2017)

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Global incidence of malignant brain and other central nervous system tumors by histology, 2003–2007 (2017)

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Socioeconomic Inequalities in Cancer Incidence in Europe: A Comprehensive Review of Population-based Epidemiological Studies (2020)

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The relationship between survival and socio-economic status for head and neck cancer in Canada (2014)

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Comparison between poor and long-term survivors with glioblastoma: review of an Australian dataset (2014)

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