Two major new studies conducted by scientists from the American Cancer Society (ACS) indicate an increase in the use of proton radiation therapy (PLT) for the treatment of cancer patients in the United States over the past decade. However, black patients were less likely to receive PLT than whites, and racial inequality is growing. The results of the study were published in the JAMA Network Open.
"We found that nationwide, between 2004 and 2018, the use of PLT for the treatment of all cancers falling into the corresponding category increased. This is especially true for those tumors for which PLT is the recommended method of radiation therapy," said Dr. Leticia Nogueira, senior researcher in the Department of Health Research at the American Cancer Society and lead author of both studies. "Of particular concern is the fact that, as it turned out, racial inequality has grown along with the increase in the availability of PLT in the United States."
Proton therapy is a method of radiotherapy used to destroy cancer cells. Unlike traditional (photonic) radiation therapy, high-energy proton beams are used in PLT, which more accurately affect neoplasms and less damage the surrounding healthy tissues. Proton treatment is more effective than photons in the treatment of tumors with complex anatomy, tumors surrounded by sensitive tissues, as well as oncological diseases in children. PLT can be twice as expensive as treatment with traditional radiation therapy.
For both studies, the researchers used the National Cancer Database, an oncological registry compiled with the help of hospitals and sponsored by the American College of Surgeons in conjunction with ACS. This database includes more than 1,500 medical institutions accredited by the Commission on Oncological Diseases, and accumulates information on the treatment of more than 70% of patients with diagnosed cancer in the United States. To evaluate the PLT models, these data were analyzed in accordance with the provisions of the American Society of Radiation Oncology (ASTRO). The document lists the types of cancer for which PLT is the recommended treatment method, and also those for which the effectiveness of protons is still being evaluated.
The data of almost six million patients with newly discovered oncological diseases were analyzed. In general, proton treatment in the United States increased from 0.4% in 2004 to 1.2% in 2018. Private health insurance was the most common type of financing among patients to whom PLT was recommended as radiation therapy. While the state Medicare program most often paid for the treatment of patients treated with protons for cancer, for which the effectiveness of this method is still being studied.
The researchers also found that black patients were less likely to receive treatment with PLT than white patients (0.3% vs. 0.5%), especially for oncological diseases for which PLT is recommended instead of photon radiation therapy. It is important to note that racial inequality in the availability of PLT increased with the increase in the number of proton centers in the United States, and this inequality persisted after additional comparison by socio-economic status or type of health insurance.
"Our results unfortunately highlight the fact that black patients are still less likely to benefit from advanced medical technologies such as PLT, despite the increased availability of recommended treatments," Dr. Nogueira added. "To eliminate this inequality, additional measures will be required in addition to increasing the number of medical institutions providing PLT."
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