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. 2024 Apr 22:11:100005.
doi: 10.1016/j.ijpt.2023.10.001. eCollection 2024 Mar.

Differences in Patterns of Care and Referral Between Proton and Photon Therapy

Shaakir Hasan  1   2 , Vivek Verma  1 , Stephen Abel  1 , Rodney E Wegner  1 , J Isabelle Choi  2 , Robert H Press  2 , Arpit Chhabra  2 , Charles B Simone 2nd  2
Affiliations

Differences in Patterns of Care and Referral Between Proton and Photon Therapy

Shaakir Hasan et al. Int J Part Ther. .

Abstract

Purpose: To report demographic and clinical characteristics of patients who were more likely to receive proton beam therapy (PBT) than photon therapy from facilities with access to proton centers.

Materials and methods: We utilized the national cancer database to identify the facilities with access to PBT between 2004 and 2015 and compared the relative usage of photons and PBT for demographic and clinical scenarios in breast, prostate, and nonsmall cell cancer.

Results: In total, 231 facilities with access to proton centers accounted for 168 323 breast, 39 975 lung, and 77 297 prostate cancer patients treated definitively. Proton beam therapy was used in 0.5%, 1.5%, and 8.9% of breast, lung, and prostate cases. Proton beam therapy was correlated with a farther distance traveled and longer start time from diagnosis for each site (P < .05).For breast, demographic correlates of PBT were treatment in the west coast (odds ratio [OR] = 4.81), age <60 (OR = 1.25), white race (OR = 1.94), and metropolitan area (OR = 1.58). Left-sided cancers (OR = 1.28), N2 (OR = 1.71), non-ER+/PR+/Her2Neu- cancers (OR = 1.24), accelerated partial breast irradiation (OR = 1.98), and hypofractionation (OR = 2.35) were predictors of PBT.For nonsmall cell cancer, demographic correlates of PBT were treatment in the south (OR = 2.6), metropolitan area (OR = 1.72), and Medicare insurance (OR = 1.64). Higher comorbid score (OR = 1.36), later year treated (OR = 3.16), and hypofractionation (not SBRT) (OR = 3.7) were predictors of PBT.For prostate, correlates of PBT were treatment in the west coast (OR = 2.48), age <70 (OR = 1.19), white race (OR = 1.41), metropolitan area (OR = 1.25), higher income/education (OR = 1.25), and treatment at an academic center (OR = 33.94). Lower comorbidity score (OR = 1.42), later year treated (OR = 1.37), low-risk disease (OR = 1.45), definitive compared to postoperative (OR = 6.10), and conventional fractionation (OR = 1.64) were predictors of PBT.

Conclusion: Even for facilities with established referrals to proton centers, PBT utilization was low; socioeconomic status was potentially a factor. Proton beam therapy was more often used with left-sided breast and low-risk prostate cancers, without a clear clinical pattern in lung cancer.

Keywords: Disparities; Proton centers; Referral patterns.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Combined (weighted by disease site) proton beam therapy utilization rate by region. Abbreviation: PBT, proton beam therapy.
Figure 2
Figure 2
Proportion of proton beam therapy covered by private insurance by region and disease site. Abbreviations: NSCLC, nonsmall cell cancer; PBT, proton beam therapy.
Figure 3
Figure 3
(a) Forest plot depicting the odds ratios (ORs) for receiving XRT or PBT following multivariable analysis in breast cancer. (b) Forest plot depicting the ORs for receiving XRT or PBT following multivariable analysis in NSCLC. (c) Forest plot depicting the ORs for receiving XRT or PBT following multivariable analysis in prostate cancer. Abbreviations: APBI, accelerated partial breast irradiation; NSCLC, nonsmall cell cancer; PBT, proton beam therapy; SBRT, stereotactic body radiotherapy; and XRT, photon radiotherapy.
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