Where Do Patients With Cancer in Iowa Receive Radiation Therapy? (original) (raw)
Related papers
Geospatial health, 2018
Few studies of breast cancer treatment have focused on the Northern Plains of the United States, an area with a high mastectomy rate. This study examined the association between geographic access to radiation therapy facilities and receipt of breast cancer treatments among early-stage breast cancer patients in South Dakota. Based on 4,209 early-stage breast cancer patients diagnosed between 2001 and 2012 in South Dakota, the study measured geographic proximity to radiation therapy facilities using the shortest travel time for patients to the closest radiation therapy facility. Two-level logistic regression models were used to estimate for early stage cases i) the odds of mastectomy versus breast conserving surgery (BCS); ii) the odds of not receiving radiation therapy after BCS versus receiving follow-up radiation therapy. Covariates included race/ethnicity, age at diagnosis, tumour grade, tumour sequence, year of diagnosis, census tract-level poverty rate and urban/rural residence....
International Journal of Radiation Oncology*Biology*Physics, 2020
Purpose: Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. Methods and Materials: All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as 5 unplanned RTappointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. Results: Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had 2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus
Accessibility as a major determinant of radiotherapy underutilization: A population based study
Health Policy, 2007
Background and purpose: A survey was conducted of radiotherapy (RT) resources and utilization in a northwestern Italian Region in order to assess geographical variations in radiotherapy utilization rates, and the effects of infrastructure supply on accessibility. Materials and methods: The survey was conducted by analysing standardized utilization rates based on administrative records. The data were analysed at both Regional and Local Health Unit (LHU) level. Results: Wide variation was found among LHUs RT utilization rates-the sex-and age-standardized rates varied from 1.8/1000 inhabitants to more than 3/1000 inhabitants. Patients resident in LHUs with no RT service showed a lower probability of accessing RT (standardized rate ratio (SRR), 0.82; 95%IC, 0.80-0.85). The utilization rate decreased in relation to the distance between a patient's residence and the nearest RT service; the reduction was greater for patients ≥70 years of age. Conclusion: The wide geographic variation implies lack of equity in access to services. Utilization levels decreased significantly with increasing distance from the nearest RT service, distance being a barrier to access particularly for older persons. The heterogeneous distribution of services on the Regional territory seems a relevant explanation of differences in utilization rates.
Journal of oncology practice / American Society of Clinical Oncology, 2014
A majority of patients enrolled in hospice have advanced cancer. Most of them are burdened by symptoms related to uncontrolled tumor growth. Although palliative radiation therapy (RT) is highly effective, only 1% of hospice patients are ever referred. Commonly cited concerns include high treatment cost, burden of travel for multiple visits, and a perceived reluctance of radiation oncologists to deliver single-fraction RT. A clinic offering affordable RT to patients in hospice was developed to simplify the intake, reduce cost, and minimize travel to a single visit. The goal was to evaluate, simulate and plan treatment, and treat patients with a single fraction of palliative RT within a 4-hour period. The initial 18-month experience is reported in this Health Information Portability and Accountability Act-compliant report that was approved by the Viriginia Commonwealth University Institutional Review Board. Eight referrals were received from local hospice agencies that had not referre...
Delivering radiation oncology services closer to home: a tale of two regional clinics
T he effective delivery of radiation oncology services in the community oncology setting is part of the modern "closer to home" therapeutic paradigm, but remains challenging. 1,2,3,4 In Alberta, the establishment of radiation therapy (RT) facilities in smaller communities was part of the "radiation treatment corridor" strategically envisioned a decade prior to the opening of the first of these 3 centres in Lethbridge in the summer of 2010. 5,6 Prince Edward Island (PEI), saw a similar dramatic expansion of cancer services to assure timely delivery of radiation therapy on the Island as part of a wait times initiative. The culmination of a decade of preparation and planning in PEI ultimately led to the transformation from an RT program that was mainly palliative, to a modern comprehensive provincial radiation service. In both Lethbridge and PEI, transformation involved considerable work in service design, and workforce and equipment planning. 5,6 Exchanges and learning with other small radiation centres in Canada was vital in helping to formulate and implement these strategic processes. Connections with tertiary care centres enabled these smaller centres to formulate and apply quality control elements using existing guidelines, provide academic development, and participate in clinical trials, to the benefit of both patient and medical communities. This article summarizes and contrasts the functioning of the Lethbridge and PEI programs, providing lessons and models for other regional centres looking to develop a community radiation oncology service.
Geographic access to cancer care in the US
Cancer, 2008
BACKGROUND. Although access to cancer care is known to influence patient outcomes, to the authors' knowledge, little is known regarding geographic access to cancer care, and how it may vary by population characteristics. This study estimated travel time to specialized cancer care settings for the continental U.S. population and calculated per capita oncologist supply. METHODS. The closest travel times were estimated using a network analysis of the road distance weighted by travel speeds from the population or geographic centroid of every ZIP area in the continental U.S. to that of the nearest cancer care setting under consideration: National Cancer Institute (NCI)-designated Cancer Centers, academic medical centers, and oncologists. Alaska and Hawaii were excluded because travel in these states is often not road-based. Population and geographic characteristics including race/ethnicity, income, education, and region were derived from U.S. Census 2000 data and from rural-urban commuting area classifications. Oncologist supply per 100,000 residents in Hospital Referral Regions (pHRRs) was estimated by region. RESULTS. Travel times of 1 hour were estimated for 45.2% of the population to the nearest NCI Cancer Center, 69.4% to the nearest academic-based care, and 91.8% to any specialized cancer care. Native Americans, nonurban dwellers, and residents in the South had the longest travel times to the nearest NCI Cancer Center compared with the overall U.S. population (median [interquartile range (IQR)] in minutes: 155 [62-308], 173 [111-257], and 164 [70-272], vs 78 [27-172], respectively). Travel burdens persisted for Native Americans and nonurban populations across all 3 cancer care settings. For all population strata, travel times markedly increased as the degree of cancer care specialization increased. The median oncologist supply for pHRRs was 2.83 per 100,000 individuals.
Physician And Patient Barriers To Radiotherapy Service Access: Treatment Referral Implications
Cancer Management and Research, 2019
Radiotherapy is one of the mainstays of cancer treatment, and about 60% of cancer patients receive this type of treatment during their course of treatment. An evident gap between optimal and actual radiotherapy utilization proportions has recently been reported, which has been ascribed to lack of referral to radiation oncology. There are many factors influencing the radiotherapy referral, including patient anxiety about toxicity, wrong perception of efficacy and side effects by physicians and patients, insufficient knowledge of referral process. These factors, defined as barriers can be categorized in health system barriers, physician and patient barriers. In the present brief narrative review, we discussed barriers to radiotherapy referral focusing on physician and patient barriers.
Cancer Medicine
PurposeThough utilization of medical procedures has been shown to vary considerably across the United States, similar efforts to characterize variation in the delivery of radiation therapy (RT) procedures have not been forthcoming. Our aim was to characterize variation in the delivery of common RT procedures in the Medicare population. We hypothesized that delivery would vary significantly based on provider characteristics.MethodsThe Centers for Medicare and Medicaid Services (CMS) Physician and Other Supplier Public Use File was linked to the CMS Physician Compare (PC) database by physician NPI to identify and sum all treatment delivery charges submitted by individual radiation oncologists in the non‐facility‐based (NFB) setting in 2016. Multivariable logistic regression analysis was carried out to determine provider characteristics (gender, practice rurality, practice region, and years since graduation) that predicted for the delivery of 3D conformal RT (3DCRT), intensity modulate...
International Journal of Radiation Oncology*Biology*Physics, 2006
Purpose: We sought to study the effect of distance to the nearest radiation treatment facility on the use of postmastectomy radiation therapy (PMRT) in elderly women. Methods and Materials: Using data from the linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we analyzed 19,787 women with Stage I or II breast cancer who received mastectomy as definitive surgery during 1991 to 1999. Multivariable logistic regression was used to investigate the association of distance with receipt of PMRT after adjusting for clinical and sociodemographic factors. Results: Overall 2,075 patients (10.5%) treated with mastectomy received PMRT. In addition to cancer and patient characteristics, in our primary analysis, increasing distance to the nearest radiation treatment facility was independently associated with a decreased likelihood of receiving PMRT (OR ؍ 0.996 per additional mile, p ؍ 0.01). Secondary analyses revealed that the decline in PMRT use appeared at distances of more than 25 miles and was statistically significant for those patients living more than 75 miles from the nearest radiation facility (odds of receiving PMRT of 0.58 [95% CI ؍ 0.34 -0.99] vs. living within 25 miles of such a facility). The effect of distance on PMRT appeared to be more pronounced with increasing patient age (>75 years). Variation in the effect of distance on radiation use between regions of the country and nodal status was also identified. Conclusions: Oncologists must be cognizant of the potential barrier to quality care that is posed by travel distance, especially for elderly patients; and policy makers should consider this fact in resource allocation decisions about radiation treatment centers.
Advances in Radiation Oncology
Introduction: African Americans experience the highest burden of cancer incidence and mortality in the United States and have been persistently less likely to receive interventional care, even when such care has been proven superior to conservative management by randomized controlled trials. The presence of disparities in access to radiation therapy (RT) for African American cancer patients has rarely been examined in an expansive fashion. Methods and materials: An extensive literature search was performed using the PubMed database to examine studies investigating disparities in RT access for African Americans. Results: A total of 55 studies were found, spanning 11 organ systems. Disparities in access to RT for African Americans were most prominently study in cancers of the breast (23 studies), prostate (7 studies), gynecologic system (5 studies), and hematologic system (5 studies). Disparities in RT access for African Americans were prevalent regardless of organ system studied and often occurred independently of socioeconomic status. Fifty of 55 studies (91%) involved analysis of a populationbased database such as Surveillance, Epidemiology and End Result (SEER; 26 studies), SEER-Medicare (5 studies), National Cancer Database (3 studies), or a state tumor registry (13 studies). Conclusions: African Americans in the United States have diminished access to RT compared with Caucasian patients, independent of but often in concert with low socioeconomic status. These findings underscore the importance of finding systemic and systematic solutions to address these inequalities to reduce the barriers that patient race provides in receipt of optimal cancer care.