背景:超过一半的癌症患者接受放疗,这通常需要每天治疗数周。地理和社会人口统计学因素对癌症患者被推荐放疗的几率的影响,开始放疗,和完成放射治疗不是很好的理解。
方法:这是一项回顾性患者队列研究,包括2018年1月1日至2021年12月31日在国家癌症数据库中诊断为10种最常见实体癌之一的患者。主要预测因素是从患者家到癌症治疗医院的径向距离。其他协变量包括基线患者特征(年龄,性别,合并症,转移性疾病,癌症部位),社会人口统计学特征(种族,种族,中位数收入四分位数,保险状态),地理区域,和设施类型。三个主要结果是推荐放疗,开始推荐的放疗,完成放射治疗。
结果:在3,068,919名患者中,与居住在<10英里外的患者相比,居住在>50英里外的患者被推荐接受放疗的几率较低.与白人患者相比,亚裔和西班牙裔患者被推荐放疗的几率较低,Black患者开始推荐放疗的几率较低.没有保险的病人,那些有医疗补助或医疗保险的人,中位收入四分位数较低的患者开始或完成放疗的几率较低.
结论:地理和社会人口统计学因素会影响癌症治疗中不同水平的放疗,了解这些因素可以帮助决策者和实践识别和支持高危患者。
BACKGROUND: More than half of patients with cancer receive radiotherapy, which often requires daily treatments for several weeks. The impact of geographic and sociodemographic factors on the odds of patients with cancer being recommended radiotherapy, starting radiotherapy, and completing radiotherapy is not well understood.
METHODS: This was a retrospective patient cohort study that included patients diagnosed with one of the 10 most common solid cancers from January 1, 2018, to December 31, 2021, in the National Cancer Database. The primary predictor was radial distance from a patient\'s home to their cancer treatment hospital. Other covariates included baseline patient characteristics (age, sex, comorbidities, metastatic disease, cancer site), sociodemographic characteristics (race, ethnicity, median income quartile, insurance status), geographic region, and facility type. The three primary outcomes were being recommended radiotherapy, starting recommended radiotherapy, and completing radiotherapy.
RESULTS: Of the 3,068,919 patients included, patients living >50 miles away had lower odds of being recommended radiotherapy than those living <10 miles away. Compared to White patients, Asian and Hispanic patients had lower odds of being recommended radiotherapy, and Black patients had lower odds of starting recommended radiotherapy. Uninsured patients, those with Medicaid or Medicare, and patients in lower median income quartiles had lower odds of starting or completing radiotherapy.
CONCLUSIONS: Geographic and sociodemographic factors impact access to radiotherapy at different levels in cancer care and understanding these factors could aid policymakers and practices in identifying and supporting at-risk patients.