Geospatial Disparities in Access to Proton Therapy in the Continental United States

Maillie, Luke; Lazarev, Stanislav; Simone, Charles B.; Sisk, Matthew

doi:10.1080/07357907.2021.1944180

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…There are now 43 operational particle facilities in the United States, 9 up from 36 only 2 years ago in 2020. 10 A safe and tolerable dose is especially important in the palliative setting, where the primary objective of treatment is to improve quality of life, and thus toxicity should be minimal to meet the goals of therapy. 1 To reduce toxicity with photons, low doses are often employed in the palliative setting.…”

Section: Discussionmentioning

confidence: 99%

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Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

Berlin,

Eisenberg,

Hill‐Kayser

et al. 2023

Pediatric Blood & Cancer

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BackgroundThe intent of this study is to characterize indications for pediatric palliative‐intent proton radiation therapy (PIPRT).ProcedureWe retrospectively reviewed patients 21 years and younger who received PIPRT. We defined PIPRT as radiotherapy (RT) aimed to improve cancer‐related symptoms/provide durable local control in the non‐curative setting. Mixed proton/photon plans were included. Adjacent re‐irradiation (reRT) was defined as a reRT volume within the incidental dose cloud of a prior RT target, whereas direct reRT was defined as in‐field overlap with prior RT target. Acute toxicity during RT until first inspection visit was graded according to the Common Terminology Criteria for Adverse Events. The Kaplan–Meier method, measured from last PIPRT fraction, was used to assess progression‐free survival (PFS) and overall survival (OS).ResultsEighteen patients underwent PIPRT between 2014 and 2020. Median age at treatment start was 10 years [2–21]. Median follow‐up was 8.2 months [0–48]. Treatment sites included: brain/spine [10], abdomen/pelvis [3], thorax [3], and head/neck [2]. Indications for palliation included: durable tumor control [18], neurologic symptoms [4], pain [3], airway compromise [2], and great vessel compression [1]. Indications for protons included: reRT [15] (three adjacent, 12 direct), craniospinal irradiation [4], reduction of dose to normal tissues [3]. Sixteen experienced grade (G) 1–2 toxicity; two G3. There were no reports of radionecrosis. Median PFS was 5.3 months [95% confidence interval (CI): 2.7–16.3]. Median OS was 8.3 months [95% CI: 5.5–26.3].ConclusionsThe most common indication for PIPRT was reRT to provide durable tumor control. PIPRT appears to be safe, with no cases of high‐grade toxicity.

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Section: Discussionmentioning

confidence: 99%

“…In the future, proton RT may become more accessible as its use continues to grow. There are now 43 operational particle facilities in the United States, 9 up from 36 only 2 years ago in 2020 10 …”

Section: Discussionmentioning

confidence: 99%

Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

Berlin,

Eisenberg,

Hill‐Kayser

et al. 2023

Pediatric Blood & Cancer

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“…This needs to be assessed in larger studies with long-term follow-up. With continued refinement and optimization of delivery and increased PBT patient access [65] , this treatment approach has the potential to emerge as the modality that provides maximum benefit with the least toxicity for selected EBC patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and toxicities after proton partial breast radiotherapy for early stage, hormone receptor positive breast cancer: 3-Year results of a phase II multi-center trial

Choi

Prabhu²,

Hartsell³

et al. 2022

Clinical and Translational Radiation Oncology

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“…Travel-Time Disparities in Access to Proton Beam Therapy for Cancer Treatment Maillie et al 6 published a brief report in 2021 describing PBT accessibility for the 36 facilities operational in the US at that time, with a specific focus on differences between adult and pediatric populations. 6 Median drive times for pediatric (1.61 hours) and adult (1.64 hours) populations were reported. They additionally reported findings by state and US region, showing large variation across these levels.…”

Section: Jama Network Open | Oncologymentioning

confidence: 99%

“…Geographic accessibility, in particular drive time and driving distance, is associated with patient utilization of both proton and photon radiotherapy. 4 , 5 A prior investigation by Mallie et al 6 in 2021 described variation in PBT drive-time accessibility among 36 facilities, with a focus on pediatric and adult populations and disparities at the state and regional level. However, that analysis was largely descriptive in nature without an attempt to address potential confounding between causative variables to explain disparities observed.…”

Section: Introductionmentioning

confidence: 99%

Travel-Time Disparities in Access to Proton Beam Therapy for Cancer Treatment

Burus,

VanHelene,

Rooney

et al. 2024

JAMA Netw Open

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ImportanceProton beam therapy is an emerging radiotherapy treatment for patients with cancer that may produce similar outcomes as traditional photon-based therapy for many cancers while delivering lower amounts of toxic radiation to surrounding tissue. Geographic proximity to a proton facility is a critical component of ensuring equitable access both for indicated diagnoses and ongoing clinical trials.ObjectiveTo characterize the distribution of proton facilities in the US, quantify drive-time access for the population, and investigate the likelihood of long commutes for certain population subgroups.Design, Setting, and ParticipantsThis population-based cross-sectional study analyzed travel times to proton facilities in the US. Census tract variables in the contiguous US were measured between January 1, 2017, and December 31, 2021. Statistical analysis was performed from September to November 2023.ExposuresDrive time in minutes to nearest proton facility. Population totals and prevalence of specific factors measured from the American Community Survey: age; race and ethnicity; insurance, disability, and income status; vehicle availability; broadband access; and urbanicity.Main Outcomes and MeasuresPoor access to proton facilities was defined as having a drive-time commute of at least 4 hours to the nearest location. Median drive time and percentage of population with poor access were calculated for the entire population and by population subgroups. Univariable and multivariable odds of poor access were also calculated for certain population subgroups.ResultsGeographic access was considered for 327 536 032 residents of the contiguous US (60 594 624 [18.5%] Hispanic, 17 974 186 [5.5%] non-Hispanic Asian, 40 146 994 [12.3%] non-Hispanic Black, and 195 265 639 [59.6%] non-Hispanic White; 282 031 819 [86.1%] resided in urban counties). The median (IQR) drive time to the nearest proton facility was 96.1 (39.6-195.3) minutes; 119.8 million US residents (36.6%) lived within a 1-hour drive of the nearest proton facility, and 53.6 million (16.4%) required a commute of at least 4 hours. Persons identifying as non-Hispanic White had the longest median (IQR) commute time at 109.8 (48.0-197.6) minutes. Multivariable analysis identified rurality (odds ratio [OR], 2.45 [95% CI, 2.27-2.64]), age 65 years or older (OR, 1.09 [95% CI, 1.06-1.11]), and living below the federal poverty line (OR, 1.22 [1.20-1.25]) as factors associated with commute times of at least 4 hours.Conclusions and RelevanceThis cross-sectional study of drive-time access to proton beam therapy found that disparities in access existed among certain populations in the US. These results suggest that such disparities present a barrier to an emerging technology in cancer treatment and inhibit equitable access to ongoing clinical trials.

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Geospatial Disparities in Access to Proton Therapy in the Continental United States

Cited by 10 publications

References 18 publications

Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

Outcomes and toxicities after proton partial breast radiotherapy for early stage, hormone receptor positive breast cancer: 3-Year results of a phase II multi-center trial

Travel-Time Disparities in Access to Proton Beam Therapy for Cancer Treatment

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