OBJECTIVES: Glioma, the most frequent malignant brain tumor, presents significant challenges regarding patient survival and treatment. Survival in high-grade glioma, including glioblastoma, is typically around one year. Systemic first-line treatments are associated with toxicity; second-line treatment remains unstandardized. This review aimed to characterize the burden and unmet needs in glioma care.

METHODS: A systematic literature review was performed on clinical outcomes, unmet needs, and the humanistic and economic burden of glioma. Searches were run in Embase (April 2023).

RESULTS: The review included 147 articles. Glioma incidence increases with age and is higher in men than women by up to 56%, dependent on age. Resection is the initial treatment, followed by radiotherapy and alkylating agent chemotherapy. Notably, only one in three US patients with glioblastoma receives second-line treatment. Severe hematological toxicities are observed in glioma treatment with alkylating agent chemotherapy, including thrombocytopenia and neutropenia. Toxicity accounts for 10–20% of procarbazine/lomustine/vincristine discontinuations. Lomustine monotherapy, meanwhile, is a cornerstone of standard care and the de facto control in clinical trials for recurrent glioblastoma.

Patient quality of life (QoL) is impaired by disease symptoms and progression. Evidence on post-surgical, long-term QoL is conflicting, but patients frequently report depression, anxiety, and fatigue.

Glioma, especially glioblastoma, incurs substantial costs. In the US, post-diagnosis per-patient costs of newly diagnosed glioblastoma reach nearly $100,000, and almost $125,000 if progressing beyond first-line treatment. Lost productivity is another concern, with 41% of patients unfit to work. Existing treatments, including temozolomide and tumor treating fields, have shown poor value for money in several settings.

CONCLUSIONS: Glioma care requires multiple improvements to alleviate the clinical, humanistic, and economic burden on patients, caregivers, and healthcare systems. This includes better toxicity management to increase the use of and adherence to second-line treatment, and further research on the cost-utility of new and existing treatments.