Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
Department of Radiation Oncology, Department of Radiation Oncology, Massachusetts General Hospital, Boston.
JAMA Netw Open. 2022 Apr 1;5(4):e229025. doi: 10.1001/jamanetworkopen.2022.9025.
Proton beam therapy (PBT) is a potentially superior technology to photon radiotherapy for tumors with complex anatomy, those surrounded by sensitive tissues, and childhood cancers.
To assess patterns of use of PBT according to the present American Society of Radiation Oncology (ASTRO) clinical indications in the US.
DESIGN, SETTING, AND PARTICIPANTS: Individuals newly diagnosed with cancer between 2004 and 2018 were selected from the National Cancer Database. Data analysis was performed from October 4, 2021, to February 22, 2022. ASTRO's Model Policies (2017) were used to classify patients into group 1, for which health insurance coverage for PBT treatment is recommended, and group 2, for which coverage is recommended only if additional requirements are met.
Use of PBT.
Of the 5 919 368 patients eligible to receive PBT included in the study, 3 206 902 were female (54.2%), and mean (SD) age at diagnosis was 62.6 (12.3) years. Use of PBT in the US increased from 0.4% in 2004 to 1.2% in 2018 (annual percent change [APC], 8.12%; P < .001) due to increases in group 1 from 0.4% in 2010 to 2.2% in 2018 (APC, 21.97; P < .001) and increases in group 2 from 0.03% in 2014 to 0.1% in 2018 (APC, 30.57; P < .001). From 2010 to 2018, among patients in group 2, PBT targeted to the breast increased from 0.0% to 0.9% (APC, 51.95%), and PBT targeted to the lung increased from 0.1% to 0.7% (APC, 28.06%) (P < .001 for both). Use of PBT targeted to the prostate decreased from 1.4% in 2011 to 0.8% in 2014 (APC, -16.48%; P = .03) then increased to 1.3% in 2018 (APC, 12.45; P < .001). Most patients in group 1 treated with PBT had private insurance coverage in 2018 (1039 [55.4%]); Medicare was the most common insurance type among those in group 2 (1973 [52.5%]).
The findings of this study show an increase in the use of PBT in the US between 2004 to 2018; prostate was the only cancer site for which PBT use decreased temporarily between 2011 and 2014, increasing again between 2014 and 2018. These findings may be especially relevant for Medicare radiation oncology coverage policies.
对于具有复杂解剖结构、周围有敏感组织和儿童癌症的肿瘤，质子束疗法（PBT）是一种优于光子放射疗法的潜在技术。
根据美国放射肿瘤学会（ASTRO）目前的临床指征，评估美国 PBT 的使用模式。
设计、设置和参与者：从国家癌症数据库中选择 2004 年至 2018 年间新诊断患有癌症的个体。数据分析于 2021 年 10 月 4 日至 2022 年 2 月 22 日进行。ASTRO 的模型政策（2017 年）用于将患者分为第 1 组，建议对其进行 PBT 治疗的医疗保险覆盖，以及第 2 组，仅在满足额外要求的情况下才建议覆盖。
PBT 的使用情况。
在本研究中，纳入的 5919368 名符合接受 PBT 治疗条件的患者中，有 3206902 名女性（54.2%），诊断时的平均（SD）年龄为 62.6（12.3）岁。由于第 1 组从 2010 年的 0.4%增加到 2018 年的 2.2%（年百分比变化[APC]，21.97%；P<0.001），美国的 PBT 使用量从 2004 年的 0.4%增加到 2018 年的 1.2%（APC，8.12%；P<0.001）。第 2 组从 2014 年的 0.03%增加到 2018 年的 0.1%（APC，30.57%；P<0.001）。从 2010 年到 2018 年，在第 2 组的患者中，针对乳房的 PBT 从 0.0%增加到 0.9%（APC，51.95%），针对肺部的 PBT 从 0.1%增加到 0.7%（APC，28.06%）（均 P<0.001）。针对前列腺的 PBT 使用从 2011 年的 1.4%下降到 2014 年的 0.8%（APC，-16.48%；P=0.03），然后在 2018 年增加到 1.3%（APC，12.45%；P<0.001）。2018 年，第 1 组中接受 PBT 治疗的大多数患者拥有私人保险（1039 名[55.4%]）；第 2 组中最常见的保险类型是医疗保险（1973 名[52.5%]）。
本研究结果显示，2004 年至 2018 年间美国 PBT 的使用有所增加；前列腺是唯一一个在 2011 年至 2014 年间暂时减少 PBT 使用的癌症部位，之后在 2014 年至 2018 年间再次增加。这些发现可能对医疗保险辐射肿瘤学覆盖政策特别重要。
Zotero 插件
