Daniel V Wakefield1, Matthew Carnell2, Austin P H Dove3, Drucilla Y Edmonston4, Wesley B Garner4, Adam Hubler2, Lydia Makepeace2, Ryan Hanson5, Esra Ozdenerol5, Stephen G Chun6, Sharon Spencer7, Maria Pisu8, Michelle Martin9, Bo Jiang10, Rinaa S Punglia11, David L Schwartz12. 1. Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts. 2. University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee. 3. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee. 5. Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, Tennessee. 6. Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas. 7. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama. 8. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 9. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. 10. Department of Radiation Oncology, Biostatistics, University of Tennessee Health Science Center, Memphis, Tennessee. 11. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts. 12. Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Electronic address: dschwar4@uthsc.edu.
Abstract
PURPOSE: Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. METHODS AND MATERIALS: All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. RESULTS: Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions. CONCLUSIONS: Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.
PURPOSE: Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. METHODS AND MATERIALS: All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. RESULTS: Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions. CONCLUSIONS: Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.
Authors: Smita Bhatia; Wendy Landier; Electra D Paskett; Katherine B Peters; Janette K Merrill; Jonathan Phillips; Raymond U Osarogiagbon Journal: J Natl Cancer Inst Date: 2022-07-11 Impact factor: 11.816
Authors: Alex T Price; Casey Canfield; Geoffrey D Hugo; James A Kavanaugh; Lauren E Henke; Eric Laugeman; Pamela Samson; Clair Reynolds-Kueny; Elizabeth A Cudney Journal: JCO Glob Oncol Date: 2022-05
Authors: Daniel V Wakefield; Thomas Eichler; Emily Wilson; Liz Gardner; Casey Chollet-Lipscomb; David L Schwartz Journal: Int J Radiat Oncol Biol Phys Date: 2022-02-03 Impact factor: 8.013
Authors: Tamir N Sholklapper; Michael L Creswell; Alexandra T Payne; Michael Markel; Abigail Pepin; Michael Carrasquilla; Alan Zwart; Malika Danner; Marilyn Ayoob; Thomas Yung; Brian Collins; Deepak Kumar; Nima Aghdam; Simeng Suy; Ryan A Hankins; Keith Kowalczyk; Sean P Collins Journal: Front Oncol Date: 2022-03-25 Impact factor: 6.244
Authors: Adam Hubler; Daniel V Wakefield; Lydia Makepeace; Matt Carnell; Ankur M Sharma; Bo Jiang; Austin P Dove; Wesley B Garner; Drucilla Edmonston; John G Little; Esra Ozdenerol; Ryan B Hanson; Michelle Y Martin; Arash Shaban-Nejad; Maria Pisu; David L Schwartz Journal: Adv Radiat Oncol Date: 2022-07-30