3034 - Disparities in Utilization of Proton Therapy for Pediatric Cancers: An NCDB Analysis

05:00pm - 06:00pm PT

Hall F

Screen: 29

POSTER

Presenter(s)

Steve Braunstein, MD, PhD - University of California, San Francisco, San Francisco, CA

S. E. Braunstein¹, A. McCook-Veal², Y. Liu³, and N. Esiashvili⁴; ¹Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, ²Winship Cancer Institute of Emory University, Atlanta, GA, ³Department of Biostatistics and Bioinformatics, Emory Winship Cancer Institute, Atlanta, GA, ⁴Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA

Purpose/Objective(s):

Proton beam therapy (PBT) is a preferred treatment modality for many pediatric malignancies, with increasing evidencing supporting reduction in late toxicity, as compared with photon radiotherapy (PRT). However, as a limited resource, there may exist disparities in access and utilization. This National Cancer Database study (NCDB) seeks to assess the utilization of PBT vs PRT based on patient and disease determinants.

Materials/Methods:

The 2021 NCDB was interrogated for patients aged 0-18 years who received radiotherapy (PBT and PRT) for solid malignancy subtypes diagnosed between 2004-2021 (n=8633 patients). Univariate (UVA) and multivariate (MVA) logistical regression were performed to calculate odds ratio (OR) for utilization of PBT as associated with patient sociodemographic and clinical characteristics, including age, sex, race, ethnicity, insurance status, distance to center, days to radiation treatment from diagnosis, and duration of radiation treatment.

Results:

Median age at diagnosis was 9 years (IQR 5-13). 55.7% of patients were male and 75.6% where white. 94.3% of patients were treated for primary brain tumors. 54.5% of patients received radiotherapy in dense urban locales. Over the entire period, 80.3% vs 19.7% of patients received PRT vs PBT, respectively, though with increasing use of PBT in the recent tertile period, 2016-2021 (66.2% vs 33.8%, p<0.001). There was greater mean time (±SD) to receipt of PBT vs PRT from date of diagnosis (75±84 vs. 53±91 days, respectively, p<0.001). PBT also demonstrated longer treatment courses (p<0.004). On UVA, patients who were black (OR 0.67), uninsured (OR 0.67), in the lower income quartile (OR 0.57), or in a rural locale (OR 0.82) were less likely to receive PBT (p<0.001). Distance from treatment center was also associated with decreased PBT use (p<0.001). There were trends towards decreased use of PBT for females (OR 0.88, p<0.016) and soft-tissue disease sites (OR 0.55, p<0.017). On MVA, these findings remained significant (p<0.001) with less likelihood to receive PBT amongst patients who were black (OR 0.66), uninsured (OR 0.56), or living in rural locales (OR 0.93).

Conclusion:

This NCDB analysis demonstrates increases used of PBT over time, likely related to increased availability and recognition of improved late outcomes in management of pediatric malignancies. However, observed differences in PBT utilization reveal potential for delayed or disrupted treatment, as well as structural inequities to address for improved access and outcomes for all patients receiving modern multimodal therapy for pediatric cancers.