By Gary Walker MD, MPH, MS, Banner MD Anderson Cancer Center
Neal McCall, MD, a PGY4 resident at Emory University, and colleagues presented their analysis of advanced radiation therapy techniques among patients in the National Cancer Database. Radiation therapy is a key component in the treatment of many head and neck cancers, but can cause significant side effects and toxicities, some of which are related to radiation dose spillage to normal tissues. More advanced forms of radiation therapy such as intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) are better able to reduce or avoid radiation to normal tissues with the goal of reducing or avoiding side effects and improving quality of life. Randomized trials between IMRT and older radiation techniques demonstrated reduced toxicity and improved quality of life with IMRT.
The purpose of this study was to evaluate the use of advanced radiation techniques for head and neck cancer patients and the corresponding patterns of care in the United States. Using the National Cancer Database, they found that advanced radiation therapy techniques in head and neck cancer patients have significantly increased from about 78% of pertinent head and neck cancer cases in 2004 to nearly 97% in 2017. However, they identified racial, socioeconomic and geographic disparities in the adoption of advanced radiation therapy nationally. Black patients, older patients, uninsured and Medicaid patients, those treated in the Midwest and Northeast, and those treated at centers with lower head and neck cancer volume were all less likely to receive advanced radiation therapy techniques.
“Although advanced radiation therapy techniques are now widely available and often used in head and neck cancer, these concerning disparities suggest that disadvantaged patients are more likely to endure potentially preventable toxicity and worse quality of life when they do not receive more advanced radiation treatment for their head and neck cancer,” Dr. McCall commented. “I would have expected patients who lived further from their treatment center would have been more likely to be treated with older techniques, but that wasn’t the case. Patients were more likely to get advanced treatment techniques who traveled distances. This argues that many patients are seeking out advanced technology.”
In summary, there existed great disparities in the adoption of advanced radiation therapy techniques for head and neck cancer patients. Future health policies that increase access to advanced radiation therapy techniques can help address this disparity. In addition, ASTRO has existing educational opportunities to train physicians on guideline-based adoption and implementation of advanced techniques.
Abstract 17 – Standard but Not Equal: Disparities in Advanced Radiotherapy Techniques for Head and Neck Cancer in the United States was presented on February 25, 2022, during the Plenary II session.
