By Chase Doyle
Published: 07/03/2022 12:53:00
Advanced radiation therapy 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 by Neal S. McCall, MD, at the 2022 Multidisciplinary Head and Neck Cancer Symposium (Abstract 17). 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 (IMRT) or radiation therapy. by proton beam.
Study results showed that elderly patients, black patients, patients living in less educated areas, and patients living in lower median income areas (according to the census) were significantly less likely to receive a modality of advanced radiotherapy. Underinsured patients were also less likely to receive advanced techniques, the study authors reported.
These disparities in the delivery of advanced radiation therapy techniques for head and neck cancer put our most disadvantaged patients at risk for serious toxicities and a lower quality of life as a result of the treatment we provide.
—Neal S. McCall, MD
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“These disparities in the delivery 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 as a result of the treatment we provide,” said Dr. McCall, a PGY4 resident in the Department of Radiation Oncology at Emory University’s Winship Cancer Institute.
As Dr. McCall explained, sparing normal tissue with advanced radiation therapy techniques like IMRT or proton therapy can reduce the risk of serious toxicities compared to less advanced techniques like two-dimensional or three-dimensional conformal radiation therapy. Although advanced radiation therapy techniques are considered standards of care by consensus guidelines, Dr. McCall said, 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. final. Patients with early-stage glottic cancers, cutaneous primary or metastatic disease, as well as patients treated with palliative intent and those 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 dramatically between 2004 and 2012, primarily due to the adoption of IMRT. In 2004, IMRT accounted for approximately 77% of radiation therapy cases in patients with head and neck cancer, but by 2012 the proportion of IMRT cases had risen to 95%.
Although there have been incremental increases in IMRT use since 2012, Dr. McCall noted that more recent adoption of advanced radiation therapy has been spurred by the growth and expansion of radiation therapy. proton beam.
Of the 177,373 head and neck cancer patients eligible for analysis, 94.2% received advanced radiation therapy techniques, of which 93.3% received IMRT and 0.9% received 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 said.
Multivariate analysis of radiation therapy use showed that black patients, patients residing in areas with low median incomes, and patients living in areas with low rates of high school graduation were less likely to be treated with an advanced radiotherapy modality. Similarly, Medicare and Medicaid beneficiaries and uninsured patients were much less likely to receive advanced radiation therapy techniques.
Regarding disease-related factors, patients with oropharyngeal and nasopharyngeal primary tumors were significantly more likely to be treated with an advanced radiotherapy modality. Higher T-stages, higher end-stages, concurrent chemotherapy, and higher radiation dose were also correlated with advanced use of radiation therapy.
The researchers also identified geographic disparities in the adoption of advanced techniques. Patients treated in the Northeastern and Midwestern regions of the United States were less likely to receive an advanced radiation therapy modality than patients treated in the South. Patients treated at higher-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 an advanced radiation therapy technique.
“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,” Dr. McCall concluded.
Disclosure: For full disclosures from the study authors, visit astro.confex.com.
The content of this article has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the views and opinions of ASCO®.