Are disadvantaged patients less likely to receive advanced radiation therapy techniques for head and neck cancer

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By Chase Doyle
April 10, 2022


Advanced radiotherapy techniques can reduce the risk of severe and debilitating radiation-associated toxicity, but not all patients have equal access to these modalities, according to data presented at the 2022 Multidisciplinary Head and Neck Cancer Symposium.1 Retrospective analysis of the National Cancer Database between 2004 and 2017 identified multiple racial, socioeconomic, and geographic disparities in the provision of advanced radiation therapy techniques such as intensity-modulated radiation therapy or radiation beam therapy. protons.

Study results showed that elderly patients, black patients, patients living in less educated areas, and patients living in areas with lower census median income were significantly less likely to receive advanced radiation therapy modalities. Underinsured patients were also less likely to receive advanced techniques, the study authors reported.

“These disparities in the provision of advanced radiation therapy techniques for head and neck cancer put our most disadvantaged patients at risk of serious toxicities and poorer overall quality of life due to the treatment we provide,” said the study’s lead author, Neal S. McCall, MDPGY4 resident in the Department of Radiation Oncology at the Winship Cancer Institute at Emory University in Atlanta.

The disparities we identified in this study suggest that our most disadvantaged patients are more likely to suffer quality of life impairments related to less advanced radiotherapy.

—Neal S. McCall, MD

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Background and details of the study

As Dr. McCall Explained, sparing normal tissue with advanced radiation therapy techniques such as intensity-modulated radiation therapy or proton therapy can reduce the risk of serious toxicities compared to less advanced techniques such as two-dimensional or three-dimensional conformal radiation therapy. Although advanced radiation therapy techniques are considered standards of care by consensus guidelines, he added, the implementation of this modality and corresponding models of care in the United States remain unclear.

For this study, Dr. McCall and colleagues extracted data from the National Cancer Database between 2004 and 2017 for patients with any malignancy of the head and neck who were treated with intentional external beam radiation therapy. definitive. Patients with early-stage glottic cancers, cutaneous primary or metastatic disease; patients treated for palliative purposes; and patients with a missing variable in terms of irradiation modality were excluded from the analysis. Sociodemographic, facility-specific, and clinical associations with treatment receipt were assessed by logistic regression.

Disparities in the treatment of elderly, black and underinsured patients

As Dr. McCall reported, the use of advanced radiation therapy techniques increased significantly between 2004 and 2012, largely due to the adoption of intensity-modulated radiation therapy. In 2004, intensity-modulated radiation therapy accounted for approximately 77% of relevant head and neck cancer cases, but by 2017 the proportion had risen to 95%.

Although there have been incremental increases in the use of intensity-modulated radiation therapy since 2012, Dr. McCall noted that the more recent adoption of advanced radiation therapy has been affected by the growth and expansion proton beam therapy. Of the 177,373 head and neck cancer patients eligible for analysis during the study period, 94.2% received advanced radiation therapy techniques, including intensity-modulated radiation therapy (93.3%) and 0.9% proton therapy. In 2017, however, about 2.7% of patients received proton therapy.

“It’s still a small minority of patients who receive proton therapy, but there has been a significant jump over the past decade,” Dr. McCall added.

Despite the increased use of advanced radiation therapy techniques, researchers have identified racial and socioeconomic disparities in the adoption of these arrangements at the national level. Multivariate analysis of radiouse of therapy has shown that black patients, patients residing in areas with lower census median income, and patients living in areas with low high school rates graduation were less likely to be treated with advanced treatment radiotherapy techniques. Similarly, Medicare and Medicaid beneficiaries and uninsured patients were significantly less likely to receive either intensity-
modulated radiotherapy or proton therapy.

“Not all patients have benefited equally from technical advances in radiation delivery. The disparities we identified in this study suggest that our most disadvantaged patients are more likely to experience quality of life impairments related to less advanced radiation therapy,” said Dr. McCall.

  • A retrospective analysis of the National Cancer Database between 2004 and 2017 identified racial, socioeconomic, and geographic disparities in the uptake of advanced radiation therapy techniques for head and neck cancer.
  • These disparities potentially exposed disadvantaged patients to preventable toxicity and impaired quality of life.

Regarding disease-related factors, patients with oropharyngeal and nasal pharyngeal primaries were significantly more likely to be treated with an advanced radiotherapy modality. Higher T stages, more advanced stages, concurrent chemotherapy, and higher radiation dose were also correlated with advanced use of radiation therapy.

Geographic factors

Researchers also identified geographic disparities in the adoption of advanced techniques. Patients treated in the Northeast and Midwest were less likely to receive an advanced radiation therapy modality compared to patients treated in the South. Patients treated at high-volume academic centers and those who traveled a greater distance from their residence to their treatment facility, on the other hand, were more likely to receive advanced radiation therapy techniques.

“I would have expected that patients who lived further away from their treatment center would be more likely to be treated with older techniques, but that was not the case,” Dr. McCall observed. “Patients who walked long distances were more likely to receive advanced treatment techniques. This shows that many patients are looking for advanced technology.

DISCLOSURE: Dr. McCall reported no conflict of interest.

REFERENCE

1. McCall NS, Liu Y, Janopaul-Naylor J, et al: Standard but not equal: Disparities in advanced radiation therapy techniques for head and neck cancer in the United States. Multidisciplinary Symposium on Head and Neck Cancers 2022. Abstract 17. Presented February 25, 2022.


Expert Insight: Gary Walker, MD, MPH, MS

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