Gardner Ulysses, McClelland Shearwood, Deville Curtiland
Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
Adv Radiat Oncol. 2022 Mar 18;7(4):100943. doi: 10.1016/j.adro.2022.100943. eCollection 2022 Jul-Aug.
Major advances in radiation therapy (RT) for prostate cancer increase the importance of equity in the use of RT. We sought to assess the evolution of RT utilization disparities in prostate cancer to inform clinicians and health care organizations of persistent areas of need that can be addressed in their practices and policies.
A comprehensive PubMed literature search was undertaken in June 2020 and subsequently in March 2021. Studies were excluded that were not based in the United States, did not examine health disparities or inequities, did not examine RT or related resource utilization, or did not examine prostate cancer.
Of 257 studies found, 32 met inclusion criteria. Health disparities were most prominently reported by race, socioeconomic status, geographic location, insurance status, practice characteristics, and age. Older men were less likely to receive definitive RT or prostatectomy. Black men were less likely to receive curative therapy or dose-escalated RT. Black, Hispanic, and Asian men were less likely to receive proton therapy. Lower income was associated with decreased prostate-specific antigen testing and treatment with proton therapy or stereotactic body RT. Medicaid patients were less likely to receive definitive treatments. Rural residents were less likely to receive RT. Minority-serving hospitals were less likely to offer definitive treatments for prostate cancer.
Sociodemographic disparities and inequities in RT for prostate cancer persist. Robust efforts are imperative to eliminate disparities to improve outcomes for all patients with prostate cancer.
前列腺癌放射治疗（RT）的重大进展增加了公平使用RT的重要性。我们试图评估前列腺癌RT利用差异的演变情况，以便为临床医生和医疗保健机构提供信息，了解在其实践和政策中可以解决的持续存在的需求领域。
2020年6月进行了全面的PubMed文献检索，随后在2021年3月进行了检索。排除了那些不是基于美国的研究、没有研究健康差异或不平等的研究、没有研究RT或相关资源利用的研究，以及没有研究前列腺癌的研究。
在找到的257项研究中，32项符合纳入标准。健康差异最突出地体现在种族、社会经济地位、地理位置、保险状况、实践特征和年龄方面。老年男性接受根治性RT或前列腺切除术的可能性较小。黑人男性接受根治性治疗或剂量递增RT的可能性较小。黑人、西班牙裔和亚洲男性接受质子治疗的可能性较小。低收入与前列腺特异性抗原检测减少以及质子治疗或立体定向体部RT治疗减少有关。医疗补助患者接受根治性治疗的可能性较小。农村居民接受RT的可能性较小。为少数族裔服务的医院提供前列腺癌根治性治疗的可能性较小。
前列腺癌RT中的社会人口统计学差异和不平等现象仍然存在。必须做出有力努力来消除差异，以改善所有前列腺癌患者的治疗效果。
