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. 2022 Apr 1;5(4):e229025.
doi: 10.1001/jamanetworkopen.2022.9025.

Assessment of Proton Beam Therapy Use Among Patients With Newly Diagnosed Cancer in the US, 2004-2018

Leticia M Nogueira  1 , Ahmedin Jemal  1 , K Robin Yabroff  1 , Jason A Efstathiou  2
Affiliations

Assessment of Proton Beam Therapy Use Among Patients With Newly Diagnosed Cancer in the US, 2004-2018

Leticia M Nogueira et al. JAMA Netw Open. .

Abstract

Importance: Proton beam therapy (PBT) is a potentially superior technology to photon radiotherapy for tumors with complex anatomy, those surrounded by sensitive tissues, and childhood cancers.

Objective: To assess patterns of use of PBT according to the present American Society of Radiation Oncology (ASTRO) clinical indications in the US.

Design, setting, and participants: Individuals newly diagnosed with cancer between 2004 and 2018 were selected from the National Cancer Database. Data analysis was performed from October 4, 2021, to February 22, 2022. ASTRO's Model Policies (2017) were used to classify patients into group 1, for which health insurance coverage for PBT treatment is recommended, and group 2, for which coverage is recommended only if additional requirements are met.

Main outcomes and measures: Use of PBT.

Results: Of the 5 919 368 patients eligible to receive PBT included in the study, 3 206 902 were female (54.2%), and mean (SD) age at diagnosis was 62.6 (12.3) years. Use of PBT in the US increased from 0.4% in 2004 to 1.2% in 2018 (annual percent change [APC], 8.12%; P < .001) due to increases in group 1 from 0.4% in 2010 to 2.2% in 2018 (APC, 21.97; P < .001) and increases in group 2 from 0.03% in 2014 to 0.1% in 2018 (APC, 30.57; P < .001). From 2010 to 2018, among patients in group 2, PBT targeted to the breast increased from 0.0% to 0.9% (APC, 51.95%), and PBT targeted to the lung increased from 0.1% to 0.7% (APC, 28.06%) (P < .001 for both). Use of PBT targeted to the prostate decreased from 1.4% in 2011 to 0.8% in 2014 (APC, -16.48%; P = .03) then increased to 1.3% in 2018 (APC, 12.45; P < .001). Most patients in group 1 treated with PBT had private insurance coverage in 2018 (1039 [55.4%]); Medicare was the most common insurance type among those in group 2 (1973 [52.5%]).

Conclusions and relevance: The findings of this study show an increase in the use of PBT in the US between 2004 to 2018; prostate was the only cancer site for which PBT use decreased temporarily between 2011 and 2014, increasing again between 2014 and 2018. These findings may be especially relevant for Medicare radiation oncology coverage policies.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Yabroff reported serving on the Flatiron Health Equity Advisory Board, with all honoraria donated to the American Cancer Society. Dr Efstathiou reported receiving fees from Blue Earth Diagnostics, Boston Scientific, AstraZeneca, Genentech, Merck, Roivant Pharma, Myovant Sciences, Janssen, and Bayer Healthcare outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Number of Proton Beam Therapy (PBT) Facilities and PBT Use Over Time
A, National number of PBT facilities identified from the Particle Therapy Co-operative Group and number of National Cancer Database (NCDB) facilities from the Commission on Cancer. B, Total number and percent of patients treated with PBT.
Figure 2.
Figure 2.. Patients Treated With Proton Beam Therapy (PBT) by American Society of Radiation Oncology Indication Groups
Percent (A) and count (B) of patients receiving PBT.
Figure 3.
Figure 3.. Patients Treated With Proton Beam Therapy (PBT) by American Society of Radiation Oncology Model Policy Groups and Health Insurance Coverage
Proton beam therapy use by type of health insurance coverage. Percent of patients treated with PBT in group 1 (A) and group 2 (B); count of patients treated with PBT in group 1 (C) and group 2 (D).
Figure 4.
Figure 4.. Patients Treated With Proton Beam Therapy (PBT) by American Society of Radiation Oncology Model Policy Group and Age
Proton beam therapy use by age at diagnosis. Percent of patients treated with PBT in group 1 (A) and group 2 (B); count of patients treated with PBT in group 1 (C) and group 2 (D).
See this image and copyright information in PMC

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