Use of hypofractionation among underserved populations undergoing radiotherapy for cancer: Implications for policy.

Abstract

To examine the use of hypofractionation among underserved populations, with a focus on implications for policy. Using a 20% Medicare claims sample, we evaluated the receipt of hypofractionation, a short-course radiotherapy approach, among underserved versus non-underserved populations. Hypofractionation was defined based on cancer/site-specific guidelines and expert review. Underserved groups included racially/ethnically minoritized, rural, and low socioeconomic status patients. We included 4 cancer types that represent the majority of new cancer diagnoses and for which there is the highest level of support for hypofractionation. This included breast, colorectal, lung, and prostate cancer. Log-binomial regressions were used to assess the association between underserved status and hypofractionation use, adjusting for patient-level, practice-level, and area-level characteristics. We analyzed 6,437 patients, finding 2,200 classified as underserved and 4,237 as not underserved. Overall, 52.5% of patients received hypofractionation and underserved populations were treated at similar rates to their non-underserved counterparts. We noted a few exceptions. Rural prostate cancer patients had a lower likelihood of receiving hypofractionation (RR 0.59, p = 0.005), while rural lung cancer patients had a higher likelihood of receiving hypofractionation (RR 1.14, p = 0.039). Hypofractionation was received at similar rates among underserved and non-underserved populations. Given existing disparities experienced by underserved cancer patients, greater use of hypofractionation may contribute to more equitable outcomes. Implementation of policies that facilitate - rather than discourage - the use of hypofractionation, may reduce disparities experienced by underserved cancer patients.