The early adoption of intensity‐modulated radiotherapy and stereotactic body radiation treatment among older Medicare beneficiaries with prostate cancer

Abstract

Background Several new prostate cancer treatments emerged since 2000, including two radiotherapies with similar efficacy at the time of their introduction: intensity-modulated radiotherapy (IMRT) and stereotactic body radiation therapy (SBRT). We sought to compare their early adoption patterns and identify factors associated their use. Methods Using Surveillance, Epidemiology, and End Results (SEER)-Medicare, we identified prostate cancer patients treated with radiation during the five years after IMRT introduction (2001–2005) and five years after SBRT introduction (2007–2011). Our outcome was the use of new radiation therapy (i.e., IMRT or SBRT) compared with the existing standard radiation therapies at that time. We fit a series of multivariable hierarchical logistic regression models accounting for patients nested within health service areas to examine factors associated with new radiation therapy use. Results In 2001–2005, 5680 men (21%) received IMRT compared with standard radiation (n=21,555). Men receiving IMRT were older, had higher grade tumors, and lived in more populated areas (p<0.05). In 2007–2011, 595 men (2%) received SBRT compared with standard radiation (n=28,255). Men receiving SBRT were more likely to be white, had lower grade tumors, lived in more populated areas, and were more likely to live in the Northeast (p<0.05). Adjusting for cohort demographic and clinical factors, the early adoption rate for IMRT was substantially higher than for SBRT (44% versus 4%, p<0.01). Conclusions There is a stark contrast in the adoption rates of IMRT and SBRT at the time of their introduction. Further investigation of the nonclinical factors associated with this difference is warranted.

Diffusion of innovation in radiation oncology in the United States

“…This study did not attempt to show causal effects, as this can only be demonstrated by clinical trials. 25 What this study did demonstrate, however, is that there are indeed differences in innovation accessibility in RO in the United States. The connection between innovation and improved cancer survival has been made by many authors; innovation-based care models are under discussion in reimbursement healthcare reform.…”

Travel distance and stereotactic body radiotherapy for localized prostate cancer

“…Furthermore, a significant trend toward increased SBRT use continued through 2012 (the end of our study period), which coincided with the publication of several phase 2 clinical trials from 8 cancer centers suggesting that SBRT has similar early outcomes compared with other forms of radiotherapy . Nevertheless, the absolute rate of prostate SBRT during the current study period remained modest in comparison with the uptake of standard fractionation intensity‐modulated radiotherapy, most likely given the unclear long‐term implications . We would expect the rate of prostate SBRT to continue increasing after being cautiously listed as a potential definitive therapy option in the 2014 NCCN guidelines, and its use to be guided further by an ongoing phase 3 randomized noninferiority clinical trial …”

“…[8][9][10][11][12][13][14] Nevertheless, the absolute rate of prostate SBRT during the current study period remained modest in comparison with the uptake of standard fractionation intensitymodulated radiotherapy, most likely given the unclear long-term implications. 21 We would expect the rate of prostate SBRT to continue increasing after being cautiously listed as a potential definitive therapy option in the 2014 NCCN guidelines, and its use to be guided further by an ongoing phase 3 randomized noninferiority clinical trial. 22 The current study finding that long-distance travel was strongly positively associated with definitive prostate Figure 3.…”

Radiation oncologists’ attitudes and beliefs about intensity-modulated radiation therapy and stereotactic body radiation therapy for prostate cancer

“…Both these treatments demonstrate encouraging initial outcomes, including good cancer control and minimal toxicity [1,2]. Yet these treatments exhibit varying utilization patterns [3]. When IMRT emerged around 2001, it was rapidly adopted [4].…”

“…When IMRT emerged around 2001, it was rapidly adopted [4]. In contrast, SBRT's initial adoption around 2007 was more variable-generally slow with some areas of rapid uptake [3]. In addition, there is wide regional variation in the use of these two treatments, with greater use of SBRT among patients residing in urban areas and by those living in the northeast [3].…”