Shorter radiation regimens and treatment noncompletion among patients with breast and prostate cancer in the United States: An analysis of racial disparities in access and quality Journal Article
| Authors: | Dee, E. C.; Taunk, N. K.; Chino, F. L.; Deville, C. Jr; McClelland, S. 3rd; Muralidhar, V.; McBride, S. N.; Gillespie, E. F.; Yamoah, K.; Nguyen, P. L.; Mahal, B. A.; Winkfield, K. M.; Vapiwala, N.; Santos, P. M. G. |
| Article Title: | Shorter radiation regimens and treatment noncompletion among patients with breast and prostate cancer in the United States: An analysis of racial disparities in access and quality |
| Abstract: | PURPOSE: Compared with conventional external-beam radiation therapy (cEBRT) for patients with breast cancer (BC) and prostate cancer (PC), shorter radiation regimens may be associated with lower treatment noncompletion rates. We assess disparities in receipt of shorter radiation regimens and treatment noncompletion for BC and PC. PATIENTS AND METHODS: The 2004-2017 National Cancer Database was queried for adjuvant cEBRT or hypofractionated EBRT (hEBRT) for nonmetastatic BC; and definitive cEBRT, moderate hypofractionation (mEBRT), or stereotactic body radiotherapy (SBRT) for localized PC. Multivariable logistic regression identified factors associated with treatment noncompletion and receipt of shorter regimens. FINDINGS: We identified 170,386 men with PC (median age [interquartile range], 70 [64-75] years; Black, 17.5%; White, 82.5%) and 306,846 women with BC (61 [52-69] years; Black, 12.3%; White, 87.7%). Among patients who received cEBRT for PC, Black men had higher treatment noncompletion rates compared with White (14.1% v 13.0%; odds ratio [95% CI] 1.07 [1.03 to 1.12]; P < .001). In contrast, treatment noncompletion was not disparate with SBRT (Black 1.6% v White 1.3%; 1.20 [0.72 to 2.00], P = .49) or mEBRT (Black 9.0% v White 7.1%; 1.05 [0.72 to 1.54], P = .79). From 2004 to 2017, SBRT (0.07% to 11.8%; 1.32 [1.31 to 1.33]) and mEBRT (0.35% to 9.1%; 1.27 [1.25 to 1.28]) increased (both P < .001); however, Black men were consistently less likely to receive SBRT (7.4% v White, 8.3%; 0.84 [0.79 to 0.89], P < .001). Among women with BC, there were no racial differences in treatment noncompletion; however, hEBRT was associated with lower treatment noncompletion rates (1.0% v cEBRT 2.3%; 0.39 [0.35 to 0.44], P < .001). Although hEBRT for BC increased (0.8% to 35.6%) between 2004 and 2017, Black women were less likely to receive hEBRT (10.4% v 15.3%; 0.78 [0.75 to 0.81], P < .001). INTERPRETATION: Black patients were consistently less likely to receive hypofractionated radiation for PC or BC, despite evidence suggesting that shorter regimens may lower rates of treatment noncompletion with similar oncologic outcomes. |
| Keywords: | aged; united states; breast neoplasms; prostatic neoplasms; breast tumor; prostate tumor; radiosurgery; humans; human; male; radiation dose hypofractionation |
| Journal Title: | JCO Oncology Practice |
| Volume: | 19 |
| Issue: | 2 |
| ISSN: | 2688-1527 |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2023-02-01 |
| Start Page: | e197 |
| End Page: | e212 |
| Language: | English |
| DOI: | 10.1200/op.22.00383 |
| PUBMED: | 36399692 |
| PROVIDER: | scopus |
| PMCID: | PMC9970278 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Patricia Mae G. Santos -- MSK author Sean McBride's middle initial is incorrect on the original publication -- Export Date: 1 March 2023 -- Source: Scopus |
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