Black children less likely to receive proton therapy than white children
Click Here to Manage Email Alerts
Black children with solid cancers appeared less likely to receive proton radiotherapy than their white counterparts, according to an analysis of Children’s Oncology Group trial data published in a research letter in JAMA Oncology.
“We were motivated to carry out this investigation based on anecdotal experiences in clinic that children who receive proton therapy are predominantly white. The strongest evidence for proton therapy is in childhood cancer, and we were concerned that imbalances in who receives this treatment could translate to long-term health disparities among our patients,” Daphne A. Haas-Kogan, MD, chair in the department of radiation oncology at Brigham and Women’s Hospital, told Healio. “This question was particularly urgent to us because of the rapidly growing number of proton centers in the country, which could potentiate any existing disparities if there is imbalanced distribution and use of these expensive technologies.
“Racism is ingrained in our society and medicine is not immune from this racism,” Haas-Kogan added. “We felt that this effort could help us better understand where racial disparities exist, introspect on how racism in our field contributes to these disparities, and ultimately identify strategies to improve outcomes for underrepresented minority patients.”
Haas-Kogan and colleagues assessed the association of race and socioeconomic factors with proton therapy use among 1,240 children with solid malignant disease who underwent external beam radiotherapy at physician’s choice in Children’s Oncology Group (COG) prospective trials conducted between 2010 and 2018. Most children (85%; n = 1,054) received photon radiotherapy, whereas 15% (n = 186) received proton radiotherapy.
The study excluded patients in trials that only allowed emergency palliative radiotherapy or total body irradiation, were not conducted in the United States, or had missing radiotherapy modality. Race/ethnicity categories included white non-Hispanic, white-Hispanic, Black, other and unknown.
Researchers used univariate and multivariable logistic regression models to determine factors associated with radiation modality.
Results of univariate analyses showed Black children had a significantly lower likelihood of receiving proton radiotherapy than white children (OR = 0.4; 95% CI, 0.22-0.75). Proton radiotherapy use appeared less frequent among children enrolled on non-central nervous system vs. CNS trials, those with a shorter distance between the enrolling and radiotherapy institution, and those with metastatic disease.
Factors not associated with radiation modality received included insurance type, neighborhood poverty level and sex.
After adjusting for location of enrolling institution, distance to radiotherapy facility and presence of metastatic disease, researchers found that Black children remained less likely to receive proton radiotherapy than white children (OR = 0.35; 95% CI, 0.17-0.72).
“Centuries of racism in our country have directly led to Black people having less access to education, employment and adequate health care,” Haas-Kogan said. “We found that patients who receive proton therapy travel further for treatment than those who receive photon therapy, which hints that the unequal distribution of proton centers in affluent, metropolitan communities may play a role in treatment access.”
The indirect measurements of socioeconomic status, lack of granular geographic information and limited power due to the relatively fewer patients who received proton radiotherapy served as the study’s limitations.
“[Although] proton and photon radiotherapy have similar anticancer effectiveness, proton radiotherapy has improved long-term side effects and health-related quality of life in pediatric cancers,” study researcher Danielle S. Bitterman, MD, resident in the department of radiation oncology at Brigham and Women’s Hospital, told Healio. “Our study did not assess survival or patient side-effect outcomes; therefore, we cannot make conclusions about the clinical effect of the imbalance in proton treatment on patients. However, our findings suggest that Black children with solid cancers may be at higher risk for more side effects, some of which may be severe and lifelong. This disparity would be due to differences in access to expensive proton treatment and would be preventable if these treatments were distributed equitably and fairly based on each child’s medical needs.”
Researchers plan to conduct additional research to identify why Black children with cancer are less likely to receive proton radiotherapy.
“Future research should drill down on whether and how geography contributes to disparities, as this could guide more ethical distribution of high-cost technologies,” Haas-Kogan said. “Additional research into barriers to receiving proton treatment, such as financial resources and workplace flexibility, is also needed. Finally, and perhaps most importantly, health care provider bias and racism may influence referral and treatment patterns for high-cost medical treatments, which needs to be measured, recognized and addressed in order to narrow the glaring health care disparities in our country.”
For more information:
Danielle S. Bitterman, MD, can be reached at Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115; email: danielle_bitterman@dfci.harvard.edu.
Daphne A. Haas-Kogan, MD, can be reached at Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115; email: dhaas-kogan@bwh.harvard.edu.
Collapse
Read more about
Click Here to Manage Email Alerts