3040 - Physician Expertise and Patient Access to Intensity Modulated Radiotherapy for Head and Neck Cancer
Presenter(s)
X. S. Chen1, X. Zhou2, L. Green1, K. Reeder Hayes1, J. L. Lund1, T. Hackman3, S. Sheth1, D. J. Sher4, J. E. Tepper5, L. B. Marks6, and C. Baggett2; 1University of North Carolina at Chapel Hill, Chapel Hill, NC, 2university of north carolina, chapel hill, NC, 3Department of Otolaryngology, University of North Carolina School of Medicine, Chapel Hill, NC, 4Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 5Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, 6Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
Purpose/Objective(s): Lack of access to new technologies may contribute to disparities in patient outcomes after cancer treatment. We hypothesize that physician expertise affects access to intensity modulated radiotherapy (IMRT). The primary objective of this study is to compare IMRT receipt among patients with head and neck squamous cell carcinoma (HNSCC) by physician expertise.
Materials/Methods: We identified a cohort of adult patients with a new diagnosis of HNSCC between 2004 and 2019 through the North Carolina Central Cancer Registry. Key inclusion criteria were receipt of radiation therapy (RT), non-metastatic stage, and continuous insurance enrollment within 12 months before and 6 months after diagnosis. Patients were stratified into tertiles based on radiation oncologist expertise, measured by training period (year of residency completion) and patient volume (average number of patients with HNSCC treated per year). The primary outcome was receipt of IMRT vs. conventional RT, determined by claims data from private insurance, Medicaid and Medicare. The associations of physician training period and patient volume with the likelihood of receiving IMRT were estimated using logistic regression after accounting for race, residence, socioeconomic status, insurance, and diagnosis year.
Results: This cohort included 7270 patients, of whom 5005 (68.8%) received IMRT. Patients who were Black, in rural counties, at the lowest socioeconomic stratum, and with Medicaid were significantly less likely to receive IMRT on univariable analyses. Significantly more patients received IMRT when treated by physicians who completed training after 2004 (79.6%) than those who completed training before 1990 (57.9%) or between 1991-2003 (65.6%, p<0.0001). More patients received IMRT when treated by high-volume physicians (73.4%) than those treated by low (64.6%) or intermediate (64.9%) volume physicians (p<0.0001). On multivariable analysis, patients were 38% more likely to receive IMRT when treated by physicians who completed training after 2004 vs. before 1990 (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.14-1.67, p=0.0011), and 20% more likely to receive IMRT when treated by high vs. low-volume physicians (OR 1.20, 95% CI 1.01-1.44, p=0.044).
Conclusion: Disparities in access to IMRT in patients with HNSCC may be partly due to differences in training and experience of the treating physician. Physicians with greater technical and disease expertise can improve equity of new technology adoption by increasing patient volume and providing peer education for less experienced physicians.
Abstract 3040 - Table 1| Predictor | Multivariable Odds Ratio (95% Confidence Interval) |
| Physician Training Period | |
| After 2004 vs. Before 1990 | 1.38 (1.14-1.67) |
| 1991-2003 vs. Before 1990 | 1.09 (0.93-1.29) |
| Missing vs. Before 1990 | 0.90 (0.68-1.18) |
| Physician Volume | |
| High vs. Low | 1.20 (1.01-1.44) |
| Intermediate vs. Low | 0.95 (0.81-1.12) |
| Insurance | |
| Private vs. Medicare | 1.42 (1.09-1.84) |
| Medicaid vs. Medicare | 0.72 (0.61-0.86) |