PurposeDespite increasing use, proton therapy (PT) remains a relatively limited resource. The purpose of this study was to assess clinical and demographic differences in PT use for prostate cancer compared to intensity modulated radiation therapy (IMRT) at a single institution.Methods and materialsAll patients with low- and intermediate-risk prostate cancer (N = 633) who underwent definitive radiation therapy between 2010 and 2015 were divided into PT (n = 508) and IMRT (n = 125) comparison groups and compared using χ2 and independent sample t tests. Univariable and multivariable logistic regression analyses were conducted to assess the associations between PT use and demographic, clinical, and treatment characteristics.ResultsThe PT and IMRT cohorts varied by age, race, poverty, distance, treatment year, and treating physician. Patients who underwent IMRT were more likely to be older (mean age, 66 vs. 68 years), black (51% vs. 75%), and living in poverty or close to the facility (mean distance between residence and facility, 90 vs. 21 miles; P < .05). Prostate-specific antigen, prostate volume, and International Index of Erectile Function were significantly higher in the IMRT cohort (P < .05), but insurance type, risk group, tumor stage, Gleason score, and patient-reported urinary and bowel scores did not differ significantly (P > .05). Patients who underwent PT were more likely to receive hypofractionated therapy and less likely to receive androgen deprivation therapy (P < .01). On multivariable analysis, black (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.15-0.57) and other race (OR, 0.42; 95% CI, 0.20-0.90); distance (OR, 1.14; 95% CI, 1.06-1.24); treatment years 2011 (OR, 4.87; 95% CI, 2.23-10.6), 2012 (OR, 8.27; 95% CI, 3.43-19.9), and 2014 (OR, 4.44; 95% CI, 1.94-10.2) relative to 2010; and a single treating physician (OR, 0.38; 95% CI, 0.18-0.81) relative to the reference physician with the highest rate of use were associated with PT use, whereas clinical factors such as prostate-specific antigen, prostate volume, International Index of Erectile Function, and androgen deprivation therapy were not.ConclusionSociodemographic disparities exist in PT use for prostate cancer at an urban academic institution. Further investigation of potential barriers to access is warranted to ensure equitable distribution across all demographic groups.
Physicians, health care practitioners, and breast cancer advocacy groups have spent many decades investing in the promotion of breast cancer screening and early detection mechanisms, such as mammograms and breast self-examinations. These screening modalities are extremely important in reducing breast cancer incidence, prevalence, and mortality, as breast cancer screening continues to contribute to decreasing the surging mortality rate of cancerous diseases. Without the use of these screening measures, breast cancer mortality would affect many more women and exceed current statistics. While these screenings are important for the early detection of breast cancer, a more uncommon, virulent, and fatal form of breast cancer known as Inflammatory Breast Cancer (IBC) has gone largely unreported and continues to affect women. Considering IBC is an aggressive form of breast cancer with a five-year survival rate of 65%, more diligent measures and strategies are needed to educate women throughout the world about IBC.The purpose of this review is to present an overview of the literature introducing IBC, address symptoms to spread awareness, concentrate on early detection, and focus on the comprehensive treatment options of IBC.
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