Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Nursing, Baltimore, Maryland.
JAMA Netw Open. 2022 Apr 1;5(4):e228970. doi: 10.1001/jamanetworkopen.2022.8970.
Black patients are less likely than White patients to receive guideline-concordant cancer care in the US. Proton beam therapy (PBT) is a potentially superior technology to photon radiotherapy for tumors with complex anatomy, tumors surrounded by sensitive tissues, and childhood cancers.
To evaluate whether there are racial disparities in the receipt of PBT among Black and White individuals diagnosed with all PBT-eligible cancers in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study evaluated Black and White individuals diagnosed with PBT-eligible cancers between January 1, 2004, and December 31, 2018, in the National Cancer Database, a nationwide hospital-based cancer registry that collects data on radiation treatment, even when it is received outside the reporting facility. American Society of Radiation Oncology model policies were used to classify patients into those for whom PBT is the recommended radiation therapy modality (group 1) and those for whom evidence of PBT efficacy is still under investigation (group 2). Propensity score matching was used to ensure comparability of Black and White patients' clinical characteristics and regional availability of PBT according to the National Academy of Medicine's definition of disparities. Data analysis was performed from October 4, 2021, to February 22, 2022.
Patients' self-identified race was ascertained from medical records.
The main outcome was receipt of PBT, with disparities in this therapy's use evaluated with logistic regression analysis.
Of the 5 225 929 patients who were eligible to receive PBT and included in the study, 13.6% were Black, 86.4% were White, and 54.3% were female. The mean (SD) age at diagnosis was 63.2 (12.4) years. Black patients were less likely to be treated with PBT than their White counterparts (0.3% vs 0.5%; odds ratio [OR], 0.67; 95% CI, 0.64-0.71). Racial disparities were greater for group 1 cancers (0.4% vs 0.8%; OR, 0.49; 95% CI, 0.44-0.55) than group 2 cancers (0.3% vs 0.4%; OR, 0.75; 95% CI, 0.70-0.80). Racial disparities in PBT receipt among group 1 cancers increased over time (annual percent change = 0.09, P < .001) and were greatest in 2018, the most recent year of available data.
In this cross-sectional study, Black patients were less likely to receive PBT than their White counterparts, and disparities were greatest for cancers for which PBT was the recommended radiation therapy modality. These findings suggest that efforts other than increasing the number of facilities that provide PBT will be needed to eliminate disparities.
在美国，黑人患者接受符合指南的癌症治疗的可能性低于白人患者。质子束疗法（PBT）是一种比光子放射疗法更有优势的技术，适用于具有复杂解剖结构的肿瘤、被敏感组织包围的肿瘤和儿童癌症。
评估在美国所有符合 PBT 条件的癌症患者中，黑人患者和白人患者接受 PBT 的情况是否存在种族差异。
设计、地点和参与者：这项横断面研究评估了 2004 年 1 月 1 日至 2018 年 12 月 31 日期间在美国国家癌症数据库中诊断为所有符合 PBT 条件的癌症的黑人和白人患者。该数据库是一个全国性的基于医院的癌症登记处，收集有关放射治疗的数据，即使治疗是在报告机构之外进行的。美国放射肿瘤学会的模型政策用于将患者分为 PBT 是推荐的放射治疗方式的患者（第 1 组）和 PBT 疗效证据仍在研究中的患者（第 2 组）。根据国家医学研究院对差异的定义，采用倾向评分匹配来确保黑人和白人患者的临床特征和 PBT 的区域可用性具有可比性。数据分析于 2021 年 10 月 4 日至 2022 年 2 月 22 日进行。
从病历中确定患者的自我认定种族。
主要结果是接受 PBT 的情况，使用逻辑回归分析评估这种治疗方法的使用差异。
在符合 PBT 条件且纳入研究的 5225929 名患者中，13.6%为黑人，86.4%为白人，54.3%为女性。诊断时的平均（SD）年龄为 63.2（12.4）岁。与白人患者相比，黑人患者接受 PBT 的可能性更低（0.3%比 0.5%；比值比[OR]，0.67；95%CI，0.64-0.71）。第 1 组癌症的种族差异大于第 2 组癌症（0.4%比 0.8%；OR，0.49；95%CI，0.44-0.55）。第 1 组癌症中 PBT 治疗的种族差异随着时间的推移而增加（年变化率=0.09，P<0.001），在可获得数据的最近一年 2018 年最大。
在这项横断面研究中，黑人患者接受 PBT 的可能性低于白人患者，而对于 PBT 是推荐放射治疗方式的癌症，差异最大。这些发现表明，除了增加提供 PBT 的设施数量之外，还需要采取其他措施来消除差异。
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