Geographic Access to Radiation Therapy Facilities in the United States

Maroongroge, Sean; Wallington, David G.; Taylor, Paige A.; Zhu, Diana; Guadagnolo, B. Ashleigh; Smith, Benjamin D.; Yu, James B.; Ballas, Leslie K.

doi:10.1016/j.ijrobp.2021.10.144

Cited by 20 publications

(14 citation statements)

References 40 publications

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“…1 Ohio State University, Columbus, OH 2 Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA 3 Massachusetts General Hospital, Boston, MA…”

Section: Affiliationsmentioning

confidence: 99%

“…Studies have shown that radiation oncology facilities are primarily centered in metropolitan and urban areas. 3,4 Patients living at an increased distance from radiotherapy centers are less likely to undergo needed radiotherapy and more likely to experience delays in treatment. 5 In addition, insurance status is consistently associated with both access to care and cancer outcomes 6,7 with patients from racial minority groups more commonly underinsured, uninsured, or reliant on Medicaid coverage.…”

mentioning

confidence: 99%

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Hypofractionation: Contracting or Expanding Disparities in the Receipt of Radiation Therapy?

Pardo

Mamon

Jimenez

2023

JCO Oncology Practice

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“…1 Ohio State University, Columbus, OH 2 Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA 3 Massachusetts General Hospital, Boston, MA…”

Section: Affiliationsmentioning

confidence: 99%

mentioning

confidence: 99%

Hypofractionation: Contracting or Expanding Disparities in the Receipt of Radiation Therapy?

Pardo

Mamon

Jimenez

2023

JCO Oncology Practice

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“…Through analyzing the density of radiation oncologists, six studies in the United States showed significant differences between urban and rural areas, an increasingly divided gap in the choice of treatments because it is more difficult for rural patients to access essential radiation facilities. Although the percentage of US radiation facilities has increased in the past 15 years, urban areas already dense with these facilities have been disproportionately favored [ 17 ]. These observations are supported by studies showing that BCS is frequently common among women living in areas with more health facilities.…”

Section: Reviewmentioning

confidence: 99%

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Vijayakumar¹,

Nittala²,

Buddala³

et al. 2023

Cureus

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Breast conservation therapy (BCT) (usually a lumpectomy plus radiotherapy (RT)) has become a standard alternative to radical mastectomy in early-stage breast cancers with equal, if not higher, survival rates. The established standard of the RT component of the BCT had been about six weeks of Monday through Friday external beam RT to the whole breast (WBRT). Recent clinical trials have shown that partial breast radiation therapy (PBRT) to the region surrounding the lumpectomy cavity with shorter courses can result in equal local control, survival, and slightly improved cosmetic outcomes. Intraoperative RT (IORT) wherein RT is administered at the time of operation for BCT to the lumpectomy cavity as a single-fraction RT is also considered PBRT. The advantage of IORT is that weeks of RT are avoided. However, the role of IORT as part of BCT has been controversial. The extreme views go from “I will not recommend to anyone” to “I can recommend to all early-stage favorable patients.” These divergent views are due to difficulty in interpreting the clinical trial results. There are two modalities of delivering IORT, namely, the use of low-energy 50 kV beams or electron beams. There are several retrospective, prospective, and two randomized clinical trials comparing IORT versus WBRT. Yet, the opinions are divided. In this paper, we try to bring clarity and consensus from a highly broad-based multidisciplinary team approach. The multidisciplinary team included breast surgeons, radiation oncologists, medical physicists, biostatisticians, public health experts, nurse practitioners, and medical oncologists. We show that there is a need to more carefully interpret and differentiate the data based on electron versus low-dose X-ray modalities; the randomized study results have to be extremely carefully dissected from biostatistical points of view; the importance of the involvement of patients and families in the decision making in a very transparent and informed manner needs to be emphasized; and the compromise some women may be willing to accept between 2-4% potential increase in local recurrence (as interpreted by some of the investigators in IORT randomized studies) versus mastectomy. We conclude that, ultimately, the choice should be that of women with detailed facts of the pros and cons of all options being presented to them from the angle of patient/family-focused care. Although the guidelines of various professional societies can be helpful, they are only guidelines. The participation of women in IORT clinical trials is still needed, and as genome-based and omics -based fine-tuning of prognostic fingerprints evolve, the current guidelines need to be revisited. Finally, the use of IORT can help rural, socioeconomically, and infrastructure-deprived populations and geographic regions as the convenience of single-fraction RT and the possibility of breast preservation are likely to encourage more women to choose BCT than mastectomy. This option can also likely lead to more wom...

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“…Mississippi boasts 25 centers with at least one linear accelerator licensed for treatment delivery, which is one center for every 120,000 people based on the population of the state, not including the geographic regions serviced beyond state lines. According to one study, however, when evaluated based on distance to a center from any location in Mississippi, only a tiny portion of the state can be found more than 50 mi from any one of the Mississippi’s centers 5 . Fifty mi was used in the aforementioned study because a significant correlation was found for patients living beyond that distance to be much less likely to receive radiation care.…”

Section: Status Of Radiation Oncology In Cancer Care and In Mississippimentioning

confidence: 99%

Building Better Patient Care in Mississippi Radiation Oncology: Why Mississippi Needs a Collaborative Quality Initiative

Duggar¹,

Roberts²,

Thomas³

et al. 2023

Southern Medical Journal

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Objectives: Cancer is an insidious and devastating disease that affects many people. Progress in mortality rate has not been realized universally across the United States, and challenges remain in how to best make up the ground that has been lost in these areas, one of which is Mississippi. Radiation therapy is a significant contributor to cancer control rates and certain challenges exist specifically regarding this treatment modality. Methods:The challenges of radiation oncology in Mississippi have been reviewed and discussed, with the proposal of a potential collaboration between clinical practitioners and payors to provide optimal and cost-effective radiation therapy to patients in Mississippi.Results: A similar model to that proposed has been reviewed and evaluated. This model is discussed based on its potential validity and usefulness in Mississippi.Conclusions: Significant barriers exist in the state of Mississippi to patients receiving a consistent standard of care, regardless of their location and socioeconomic status. A collaborative quality initiative has been shown to be a boon to this endeavor elsewhere and stands to have a similar impact in Mississippi.

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Geographic Access to Radiation Therapy Facilities in the United States

Cited by 20 publications

References 40 publications

Hypofractionation: Contracting or Expanding Disparities in the Receipt of Radiation Therapy?

Hypofractionation: Contracting or Expanding Disparities in the Receipt of Radiation Therapy?

Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts

Building Better Patient Care in Mississippi Radiation Oncology: Why Mississippi Needs a Collaborative Quality Initiative

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