Study finds disparities in use of advanced radiation therapy techniques for head and neck cancer

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A new study has revealed racial, socioeconomic and geographic inequities in the delivery of advanced radiation therapy techniques (ART) for patients with head and neck cancer.

The study results were presented at the 2022 Multidisciplinary Head and Neck Cancer Symposium by Neal Sean McCall, MD, of Emory University’s Winship Cancer Institute in Atlanta.

Dr. McCall and colleagues extracted data from the National Cancer Database (from 2004 to 2017) for patients treated with external beam radiation therapy for primary head and neck cancer. The study excluded patients with metastatic disease and early-stage glottic laryngeal cancer.


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The primary endpoint was use of ART, which included intensity-modulated radiation therapy (IMRT) and proton therapy (PBT).

ART use over time

Researchers assessed sociodemographic, facility-specific, and clinical associations with receiving ART in 177,373 patients. Overall, 94.2% of patients received ART (of which 93.3% received IMRT and 0.9% received PBT) and 5.8% received non-ART therapy (compliant radiotherapy 2D or 3D).

The study showed a steady increase in ART use from 2004 to 2012, with use remaining stable from 2012 to 2017. The increase in ART use was primarily due to an increase in use of IMRT.

“While the use of advanced radiation therapy techniques increased significantly between 2004 and 2017, we were surprised to find that 3.1% of patients were still receiving 3D conformal radiation therapy or less sophisticated techniques even in 2017,” said Dr. McCall in an interview.

Factors related to ART use

Dr. McCall and colleagues conducted a multivariate analysis to identify factors associated with receiving ART.

The analysis showed that non-Hispanic black patients were significantly less likely to receive ART (odds ratio [OR]0.87; P <.001 than non-hispanic white patients. asian islander patients were more likely to receive art>P <.001 and the same was true for hispanic patients>P <.001>

Other groups that were significantly less likely to receive ART included older patients (continuous OR, 0.95; P P <.001 those on medicaid>P <.001 and those on medicare>P <.001>

Patients treated at facilities in the Northeast or Midwest were significantly less likely to receive ART (OR, 0.83 and 0.92, respectively; P <.001 for both increasing facility volume was associated with an increased likelihood of receiving art or>P <.001>

Compared with patients treated in academic or research institutions, patients treated in community cancer programs (OR, 0.86; P =0.002), comprehensive community cancer programs (OR, 0.71; P P

Additionally, income and education levels were significantly associated with receiving ART. Patients living in areas where a greater proportion of the population lacks a high school diploma were less likely to be treated with ART, and patients living in areas with lower census median income were less likely to be treated by ART.

“Race, age, insurance, and census-level measures of income and education were all strongly associated with receiving advanced radiation therapy techniques,” Dr. McCall said. “I think this really highlights the fact that patients have not necessarily benefited equally from innovations in our field and that the pursuit of equity should continue to be a top priority.”

Disclosures: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original reference for a full list of disclosures.

Reference

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 Head and Neck Cancer Symposium 2022. February 24-26, 2020. Abstract 17.

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