Image-guided superficial radiation therapy mends skin cancer disparities in rural areas
Key takeaways:
- Offering this radiation therapy to rural areas mends comorbidity, access and insurance barriers.
- 99.67% and 99.27% of those with a low and high comorbidity burden, respectively, achieved recurrence freedom.
Offering image-guided superficial radiation therapy to rural populations could mend health disparities in nonmelanoma skin cancer treatment, according to a study published in Cancers.
Historically, rural living has been associated with nearly a 1.5 increased risk for death when it comes to skin cancer, according to data from the American Journal of Managed Care.
“Prior research suggests neighborhood-level deprivation is associated with poor cancer outcomes, even after adjusting for other factors,” Alpesh Desai, DO, a dermatologist at Heights Dermatology, member of the board of trustees at the Orlando College of Osteopathic Medicine and an investigator the Cancers study, told Healio. “Encouragingly, our study found no differences in freedom from recurrence of nonmelanoma skin cancer (NMSC) following image-guided superficial radiation therapy (IGSRT) when analyzed by neighborhood deprivation levels.”
Cleared by the FDA in 2025 as a treatment for NMSC, IGSRT is an emerging treatment option that employs integrated, high-resolution dermal ultrasound technology to better visualize lesions for more precise radiation.
According to the study, this method of treatment for NMSC creates equal health outcomes for rural residents despite their economic status or comorbidity profile.
After analyzing 19,988 lesions, researchers of this study found that rates of freedom from NMSC recurrence were no different among less deprived vs. more deprived neighborhoods 6-years post IGSRT treatment (99.47% vs. 99.61%).
Comorbidity burdens were also a nonfactor in treatment outcomes following IGSRT treatment, with 99.67% of those with a low comorbidity burden and 99.27% of those with a high comorbidity burden also achieving 6 years of freedom from recurrence.
“The most common comorbidity was diabetes at 17.8%, which is a relative contraindication for surgery,” Desai noted. “The use of IGSRT as a surgical alternative for patients with comorbid conditions may provide superior clinical outcomes.”
According to the Institute of Medicine in 2003, rural residence is a potential risk factor for health disparities as rural hospitals typically have lower-quality clinical decision-making and diagnostic, therapeutic and monitoring processes compared with urban teaching hospitals. Additionally, urban areas are more likely to have increased access to radiation treatment.
According to Desai, rural hospitals and treatment centers should implement IGSRT into their armamentarium for NMSC due to the plethora of benefits this treatment option offers to rural residence.
“Dermatology clinics not equipped for Mohs micrographic surgery could incorporate IGSRT to expand access to NMSC treatment,” Desai explains, noting that IGSRT treatment is often more convenient for clinicians and patients as the treatment takes 15 minutes whereas Mohs micrographic surgery can take anywhere from 2 to 4 hours.
“Practices already offering Mohs could increase patient options by adding IGSRT, which can be administered by a trained radiation therapist under the supervision of the prescribing physician, allowing dermatologists to treat other patients concurrently,” Desai added.
The authors also pointed out that most Mohs surgeons do not accept Medicare, which presents a barrier to treatment among rural residence, many of which experience financial challenges. On the other hand, IGSRT is usually covered by Medicare, according to the Medicare website. Once consistently approved, IGSRT could mend this health disparity.
IGSRT is also a nonsurgical alternative for rural residents who are either unsuited or uninterested in surgical management for their NMSC. According to Desai, it should be used as a first line therapy for treatment of early stage, high-low-risk NMSCs.
“Increasing access to IGSRT in rural areas and lower socioeconomic communities could significantly improve clinical outcomes for underserved populations,” Desai told Healio. “This includes rural residents lacking access to cancer centers or lower socioeconomic patients unable to afford other treatment options.”
References:
- Radiation therapy. https://www.medicare.gov/coverage/radiation-therapy. Accessed Jan. 30, 2025.
- Skin cancer incidence highest among rural, SOC individuals. https://www.ajmc.com/view/skin-cancer-incidence-highest-among-rural-soc-individuals. Published March 19, 2024. Accessed Jan. 30, 2025.