Worsening Racial Disparities in Utilization of Intensity Modulated Radiation Therapy.
Worsening Racial Disparities in Utilization of Intensity Modulated Radiation Therapy.
复制标题
DOI：
10.1016/j.adro.2021.100887
复制
发表时间：
2022-05
影响因子：
2.3
通讯作者：
Suneja G
中科院分区：
文献类型：
--
作者：
Hutten RJ;Weil CR;Gaffney DK;Kokeny K;Lloyd S;Rogers CR;Suneja G
调强放射治疗（IMRT）与标准三维适形放射治疗相比的益处已在许多癌症部位得到证实，包括急性和晚期毒性降低、生活质量改善以及剂量递增的机会。有限的文献表明，非白人患者可能对IMRT的利用率较低。我们假设，随着近年来调强放射治疗的使用增加，种族不平等一直存在，并不成比例地影响非西班牙裔黑人（NHB）患者。我们的目的是评估IMRT利用的时间趋势，重点关注少数群体之间的差异。查询国家癌症数据库，以确定2017年接受明确意向IMRT治疗的癌症患者总数最多的10个疾病部位，这是最近一年的数据。排除包括IV期、年龄<18岁、保险状况未知、种族未知和姑息性放疗。将人种和种族变量合并，并分类为非西班牙裔白色、西班牙裔、NHB、亚裔、美洲原住民/爱斯基摩人和夏威夷/太平洋岛民。对早期（2004-2010年）和当代（2011-2017年）队列的每个疾病部位进行IMRT利用的多变量logistic回归，调整临床和人口统计学协变量。在10个选定的疾病部位中，1，010，292名患者在2004年至2017年期间接受了放射治疗作为确定性治疗的一部分。整体IMRT使用率从2004年的22.0%增加到2017年的57.8%。调整后，与非西班牙裔白色患者相比，NHB患者在2004年至2010年队列的10个疾病部位中有1个接受IMRT的可能性显著降低，在2011年至2017年队列的10个疾病部位中有5个接受IMRT的可能性显著降低。尽管人们对癌症治疗和结果的种族差异有了更高的认识，但这项研究表明，在使用调强放疗方面，尤其是对NHB患者，差异正在恶化。这些差异可能会加剧癌症结局的种族差异，因此，有必要确定差异调强放射治疗利用的潜在驱动因素。
The benefits of intensity modulated radiation therapy (IMRT) compared with standard 3-dimensional conformal radiation therapy have been demonstrated in many cancer sites and include decreased acute and late toxicity, improved quality of life, and opportunities for dose escalation. Limited literature suggests non-white patients may have lower utilization of IMRT. We hypothesized that as the use of IMRT has increased in recent years, racial inequities have persisted and disproportionately affect non-Hispanic Black (NHB) patients. We aim to evaluate temporal trends in IMRT utilization focusing on disparities among minoritized populations. The National Cancer Database was queried to identify the 10 disease sites with the highest total number of cancer patients treated with definitive intent IMRT in 2017, the most recent year for which data are available. Exclusions included stage IV, age <18 years, unknown insurance status, unknown race, and palliative intent radiation. Race and ethnicity variables were combined and classified as non-Hispanic White, Hispanic, NHB, Asian, Native American/Eskimo, and Hawaiian/Pacific Islander. Multivariable logistic regression for IMRT utilization was performed for each disease site for both early (2004-2010) and contemporary (2011-2017) cohorts, adjusting for clinical and demographic covariates. Among the 10 selected disease sites, 1,010,292 patients received radiation therapy as part of definitive treatment between 2004 and 2017. Overall IMRT utilization rates increased from 22.0% in 2004 to 57.8% in 2017. After adjustment and compared with non-Hispanic White patients, NHB patients were significantly less likely to receive IMRT in 1 of 10 disease sites in the 2004 to 2010 cohort, and 5 of 10 disease sites in the 2011 to 2017 cohort. Despite greater awareness of racial disparities in cancer care and outcomes, this study demonstrates worsening disparities in the use of IMRT, particularly for NHB patients. These differences may exacerbate racial disparities in cancer outcomes; therefore, identification of underlying drivers of differential IMRT utilization is warranted.
登录
查看更多内容
影响因子：
2.3
作者：
McClelland, Shearwood, III;Page, Brandi R.;Thomas, Charles R., Jr.
通讯作者：
Thomas, Charles R., Jr.
DOI：
10.1016/j.ijrobp.2012.09.023
发表时间：
2013-05-01
影响因子：
7
作者：
Kachnic, Lisa A.;Winter, Kathryn;Myerson, Robert J.;Goodyear, Michael D.;Willins, John;Esthappan, Jacqueline;Haddock, Michael G.;Rotman, Marvin;Parikh, Parag J.;Safran, Howard;Willett, Christopher G.
通讯作者：
Willett, Christopher G.
影响因子：
2.3
作者：
Reyngold, Marsha;Niland, Joyce;Goodman, Karyn A.
通讯作者：
Goodman, Karyn A.
DOI：
10.1017/s1742058x11000130
发表时间：
2011-04
期刊：
Du Bois review : social science research on race
影响因子：
--
作者：
Gee GC;Ford CL
通讯作者：
Ford CL
影响因子：
12.7
作者：
Samuel, Cleo A.;Landrum, Mary Beth;Keating, Nancy L.
通讯作者：
Keating, Nancy L.