The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States—Part 4: Appalachian patients

Abstract

PurposeCompared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined.Methods and materialsThe National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical).ResultsAlthough the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population.ConclusionsRegardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.

Epidemiology of acute myeloid leukemia in Virginia: Excellent survival outcomes for patients in rural Appalachia

“…Lower socioeconomic status also contributes to cancer care disparities. 26,29 Rural patients in our study had a lower education level and were more likely to live below the poverty level. However, it is important to recognize that socioeconomic status from our study was extrapolated from county data and does not reflect the individual patient socioeconomic status.…”

Disparities in the Utilization of Radiation Therapy for Prostate Cancer in the United States: A Comprehensive Review

“… 8 Maganty et al (2020) Under Treatment of Prostate Cancer in Rural Locations Population-based (Pennsylvania Cancer Registry) 51,024 Men diagnosed with localized or metastatic PCa between 2009 and 2015 Compared to urban residents, rural residents are less likely to undergo treatment. 9 McClelland et al (2020) The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States-Part 4: Appalachian patients Retrospective review/Meta-analysis N/A Literature review for studies investigating RT access disparities in Appalachian patients Data is sparse, but it is likely the use of RT for cancer is less likely in this region. 10 McClelland et al (2020) The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 1: African-American patients Retrospective review/Meta-analysis N/A Literature review to examine studies investigating disparities in RT access for African Americans (AAs) AAs less likely to receive care proven superior to conservative management.…”

“…In regard to disparities in the use of RT for prostate cancer, several studies continue to document that the use of these modalities for prostate cancer differ by race, SES, geographic location, insurance status, and age of patients. 4 , 5 , 6 , 7 , 8 , 9 Inequities, the unequal distribution of resources or care between populations or groups, leading to the avoidance or delay in the use of these technologically advanced RT techniques in vulnerable populations is a specific area of research that needs to be continually explored in radiation oncology to decrease the gap in differential outcomes. 10 …”

Postmastectomy Radiotherapy: Barriers to Implementation in a Disparate Population

“…Patients with private insurance have been demonstrated to be more likely to receive PMRT than those who were uninsured or had Medicaid coverage. [27][28][29][30] On multivariate analysis, we identified those with Medicare coverage and no insurance were up to 59 per cent less likely to receive PMRT than those with private insurance. Patients with Medicaid coverage trended toward lower PMRT rates as well.…”

“…In fact, the presence of a radiation center in an Appalachian county can reduce the mortality of high-risk rectal cancer by 12 to 47 per cent. 30 Finally, we identified the receipt of chemotherapy as the strongest predictor of PMRT compliance. This further corroborates the importance of access to care and guideline therapy as contributors to PMRT.…”