Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT.
Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT.
JCO Oncol Pract. 2022 Oct;18(10):e1694-e1703. doi: 10.1200/OP.22.00104. Epub 2022 Aug 5.
Delays in initiation of radiotherapy may contribute to inferior oncologic outcomes that are more commonly observed in minoritized populations in the United States. We aimed to examine inequities associated with delayed initiation of intensity-modulated radiotherapy (IMRT).
The National Cancer Database was queried to identify the 10 cancer sites most commonly treated with IMRT. Interval to initiation of treatment (IIT) was broken into quartiles for each disease site, with the 4 quartile classified as delayed. Multivariable logistic regression for delayed IIT was performed for each disease site using clinical and demographic covariates. Differences in magnitude of delay between subsets of patients stratified by race and insurance status were evaluated using two-sample -tests.
Among patients (n = 350,425) treated with IMRT between 2004 and 2017, non-Hispanic Black (NHB), Hispanic, and Asian patients were significantly more likely to have delayed IIT with IMRT for nearly all disease sites compared with non-Hispanic White (NHW) patients. NHB, Hispanic, and Asian patients had significantly longer median IIT than NHW patients (NHB 87 days, < .01; Hispanic 76 days, < .01; Asian 74 days, < .01; and NHW 67 days). NHW, Hispanic, and Asian patients with private insurance had shorter median IIT than those with Medicare ( < .01); however, NHB patients with private insurance had longer IIT than those with Medicare ( < .01).
Delays in initiation of IMRT in NHB, Hispanic, and Asian patients may contribute to the known differences in cancer outcomes and warrant further investigation, particularly to further clarify the role of different insurance policies in delays in advanced modality radiotherapy.
放疗启动延迟可能导致肿瘤学结果恶化，而这种情况在美国少数族裔人群中更为常见。本研究旨在探讨与调强放疗（IMRT）启动延迟相关的不公平现象。
本研究通过国家癌症数据库，确定了最常采用 IMRT 治疗的 10 种癌症部位。根据每个疾病部位的治疗开始时间间隔（IIT）将其分为四分位区间，第 4 个四分位区间被归类为延迟。对每个疾病部位，使用临床和人口统计学协变量对 IMRT 延迟 IIT 进行多变量逻辑回归分析。采用两样本 t 检验评估按种族和保险状况分层的患者亚组之间延迟程度的差异。
在 2004 年至 2017 年间接受 IMRT 治疗的 350425 例患者中，与非西班牙裔白人（NHW）患者相比，非西班牙裔黑人（NHB）、西班牙裔和亚裔患者接受几乎所有疾病部位的 IMRT 治疗时，更有可能出现放疗启动延迟。NHB、西班牙裔和亚裔患者的中位 IIT 明显长于 NHW 患者（NHB 87 天， <.01；西班牙裔 76 天， <.01；亚裔 74 天， <.01；NHW 67 天）。有私人保险的 NHW、西班牙裔和亚裔患者的中位 IIT 明显短于有医疗保险的患者（ <.01）；然而，有私人保险的 NHB 患者的 IIT 明显长于有医疗保险的患者（ <.01）。
NHB、西班牙裔和亚裔患者 IMRT 启动延迟可能导致癌症结局的已知差异，需要进一步研究，特别是要进一步阐明不同保险政策在先进模式放疗延迟中的作用。
