Use of Hypofractionation Among Underserved Populations Undergoing Radiation Therapy for Cancer: Implications for Policy.

PURPOSE: To examine the use of hypofractionation among underserved populations, with a focus on implications for policy.

METHODS AND MATERIALS: Using a 20% Medicare claims sample, we evaluated the receipt of hypofractionation, a short-course radiation therapy approach, among underserved versus nonunderserved populations. Hypofractionation was defined based on cancer/site-specific guidelines and expert review. Underserved groups included racially/ethnically minoritized, rural, and patients with low socioeconomic status. 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. These included breast, colorectal, lung, and prostate cancer. Log-binomial regression models were used to assess the association between underserved status and hypofractionation use, adjusting for patient-level, practice-level, and area-level characteristics.

RESULTS

We analyzed 6437 patients and found that 2200 were classified as underserved and 4237 as not underserved. Overall, 52.5% of patients received hypofractionation, and underserved populations were treated at similar rates to their nonunderserved counterparts. We noted a few exceptions. Rural patients with prostate cancer had a lower likelihood of receiving hypofractionation (relative risk, 0.59; P = .005), whereas rural patients with lung cancer had a higher likelihood of receiving hypofractionation (relative risk, 1.14; P = .039).

CONCLUSIONS

Hypofractionation was received at similar rates among underserved and nonunderserved populations. Given existing disparities experienced by underserved patients with cancer, 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 patients with cancer.