OBJECTIVE: Grade 4 glioma is the most common and fatal primary malignant brain tumor in adults. We sought to describe the evolution of patient care and survival of glioblastoma patients in a single-payer Canadian provincial healthcare system over a 24-year period. METHODS: Adult patients >
18 years of age with pathologically or clinically diagnosed glioblastoma (based on 4 RESULTS: We included 9,487 glioblastoma patients treated from 1994 to 2018. Median survival and 2-year survival rate improved over the study period from 6.4 to 9.4 months and 10% to 18% respectively. Older age was associated with shorter survival (median survival of 12 months at 65-74 years vs. 3 months >
85 years), less aggressive therapy, and a higher proportion of remaining lifetime spent in hospital (>
1/3 of patients >
75 years spend ≥50% their remaining survival in hospital). Time in hospital dropped by 8.9 days (95%CI 8.53-9.25) over the study period. Significant heterogeneity exists in patient management and outcome between regional treatment centers. CONCLUSIONS: The real-world prognosis for grade 4 glioma remains poor. However, an increased proportion of patients receiving maximal therapy is associated with a small but meaningful improvement in survival and decreased time in hospital, for all but the most elderly patients.