2391 - Sociodemographic Factors Associated with Proton Therapy Accessibility in NRG Oncology Trials of Locally Advanced NSCLC
Presenter(s)
B. A. Johnson1, C. Hu2, B. S. Hoppe1, C. B. Simone II3, Z. Liao4, R. Kotecha5, P. Samson6, W. A. Stokes7, Q. N. Nguyen4, S. Narayan8, A. Raben9, U. K. Iheagwara10, Y. Garces11, A. J. Wu12, D. E. Gerber13, G. M. Videtic14, J. Lyness2, and J. D. Bradley15; 1Mayo Clinic, Jacksonville, FL, 2NRG Oncology Statistics and Data Management Center, Philadelphia, PA, 3New York Proton Center, New York, NY, 4The University of Texas MD Anderson Cancer Center, Houston, TX, 5Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, 6Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, 7Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, 8Trinity Health, Ann Arbor, MI, 9Radiation Oncologists, PA; Christiana Care, Newark, DE, 10UPMC Hillman Cancer Center, Pittsburgh, PA, 11Mayo Clinic, Rochester, MN, 12Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 13University of Texas Southwestern Medical Center, Dallas, TX, 14Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, 15University of Pennsylvania/Abramson Cancer Center, Philadelphia, PA
Purpose/Objective(s): In the treatment of locally advanced non-small cell lung cancer (LA-NSCLC), proton beam therapy (PBT) has garnered significant interest due to its potential to reduce treatment-related toxicities. However, given its relative expense and scarcity, sociodemographic factors may shape those who have access to it. To explore this potential barrier, we assessed the sociodemographic profile of patients treated on recent NRG Oncology randomized controlled trials (RCT) in LA-NSCLC.
Materials/Methods: RTOG 0617 was a phase 3, 2x2 factorial RCT comparing 60 Gy and 74 Gy +/- cetuximab that enrolled 544 patients between 2007 and 2011 and did not include the use of PBT. RTOG 1308 was a phase 3 RCT of PBT vs photon therapy that enrolled 330 patients between 2014 and 2023. All patients on RTOG 1308 required PBT insurance authorization prior to randomization given inconsistency in PBT coverage by private insurers, while Medicare standardly approved PBT treatment on trial. RTOG 1308 and RTOG 0617 were approved by the NCI Central institutional review board (IRB) and/or an institution-specific IRB. Sociodemographic characteristics including age, sex, race, ethnicity, Zubrod performance status (PS), education level, marital status, and smoking history were reviewed for accrued patients from both trials. Characteristics were compared between trial populations using Chi-Square testing. Additional analysis between trials with age stratification (< 65 vs = 65 years old) based on Medicare eligibility was performed.
Results: The median age was 64 years in RTOG 0617 and 69 years in RTOG 1308. RTOG 1308 enrolled a higher proportion of patients age = 65 years (74% vs 49%, p<0.0001), racially diverse (20% vs 15% non-white, p=0.0479), of Hispanic or Latino ethnicity (10% vs 3%, p<0.0001), of lower performance status (PS 0 39% vs 57%, p<0.0001), and with a post-secondary education (56% vs 42%, p=0.0014). There were no statistically significant differences in sex, marital status, or smoking history (all p>0.05). When stratifying by age, similar statistically significant differences in race, ethnicity, performance status, and education level persisted among patients = 65 years old between trials (p<0.05). However, among patients < 65 years old, race and education level were not significantly different (p=0.21, p=0.95, respectively).
Conclusion: There was more racial and ethnic diversity observed in RTOG 1308 compared to RTOG 0617. Contributing factors may include a higher proportion of patients covered by government insurance on RTOG 1308, the high concentration of PBT centers in large urban settings with diverse patient populations, and/or more educated patients seeking treatment with PBT, among others. More work is needed to explore how treatment modality in LA-NSCLC influences patient sociodemographic profiles, especially outside of the clinical trial setting.