Aghdam Nima, Carrasquilla Michael, Wang Edina, Pepin Abigail N, Danner Malika, Ayoob Marilyn, Yung Thomas, Collins Brian T, Kumar Deepak, Suy Simeng, Collins Sean P, Lischalk Jonathan W
Department of Radiation Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States.
Front Oncol. 2021 Feb 25;10:616286. doi: 10.3389/fonc.2020.616286. eCollection 2020.
Stereotactic Body Radiation Therapy (SBRT) offers definitive treatment for localized prostate cancer with comparable efficacy and toxicity to conventionally fractionated radiotherapy. Decreasing the number of treatment visits from over 40 to five may ease treatment burden and increase accessibility for logistically challenged patients. Travel distance is one factor that affects a patient's access to treatment and is often related to geographic location and socioeconomic status. In this study, we review the demographic and geographic factors of patients treated with SBRT for prostate cancer for a single institution with over a decade of experience.
Patient zip codes from one thousand and thirty-five patients were derived from a large, prospectively maintained quality of life database for patients treated for prostate cancer with SBRT from 2008 to 2017. The geospatial distance between the centroid of each zip code to our institution was calculated using the R package Geosphere. Characteristics for seven hundred and twenty-one patients were evaluated at the time of analysis including: race, age, and insurance status. To assess the geographic reach of our institution, we evaluated the demographic features of each zip code using US Census data. Statistical comparisons for these features and their relation to distance traveled for treatment was performed using the Mann-Whitney U test. Finally, an unsupervised learning algorithm was performed to identify distinct clusters of patients with respect to median income, racial makeup, educational level, and rural residency.
Patients traveled from 246 distinct zip codes at a median distance of 11.35 miles. Forty percent of patients were African American, 6.9% resided in a rural region, and 22% were over the age of 75. Using K-means cluster analysis, four distinct patient zip-code groups were identified based on the aforementioned demographic features: Suburban/high-income (45%), Urban (30%), Suburban/low-income (17%), and Rural (8%). For each of the clusters, the average travel distance for SBRT was significantly different at 11.17, 9.26, 11.75, and 40.2 miles, respectively (p-value: <0.001).
Distinct demographic features are related to travel distance for prostate SBRT. In our large cohort, travel distance did not prevent uptake of prostate SBRT in African American, elderly or rural patient populations. Prostate SBRT offers a diverse population modern treatment for their localized prostate cancer and particularly for those who live significant distances from a treatment center.
立体定向体部放射治疗（SBRT）为局限性前列腺癌提供了根治性治疗，其疗效和毒性与传统分割放疗相当。将治疗次数从40多次减少到5次可能会减轻治疗负担，并增加后勤保障困难患者的可及性。旅行距离是影响患者接受治疗的一个因素，通常与地理位置和社会经济地位有关。在本研究中，我们回顾了一家拥有十多年经验的单一机构中接受SBRT治疗前列腺癌患者的人口统计学和地理因素。
从一个大型的、前瞻性维护的生活质量数据库中获取了1035例前列腺癌患者接受SBRT治疗的邮政编码。使用R包Geosphere计算每个邮政编码中心到我们机构的地理空间距离。在分析时评估了721例患者的特征，包括：种族、年龄和保险状况。为了评估我们机构的地理覆盖范围，我们使用美国人口普查数据评估了每个邮政编码的人口特征。使用曼-惠特尼U检验对这些特征及其与治疗旅行距离的关系进行统计比较。最后，进行了无监督学习算法，以根据中位数收入、种族构成、教育水平和农村居住情况识别不同的患者群体。
患者来自246个不同的邮政编码区域，中位距离为11.35英里。40%的患者为非裔美国人，6.9%居住在农村地区，22%的患者年龄超过75岁。使用K均值聚类分析，根据上述人口特征确定了四个不同的患者邮政编码组：郊区/高收入（45%）、城市（30%）、郊区/低收入（17%）和农村（8%）。对于每个聚类，SBRT的平均旅行距离分别为11.17、9.26、11.75和40.2英里，差异显著（p值：<0.001）。
不同的人口特征与前列腺SBRT的旅行距离有关。在我们的大型队列中，旅行距离并未阻止非裔美国人、老年或农村患者群体接受前列腺SBRT。前列腺SBRT为不同人群的局限性前列腺癌提供了现代治疗方法，特别是对于那些居住在离治疗中心较远的患者。
