1 in 6 Americans live at least 4 hours from proton beam therapy facility
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Key takeaways:
- More than 16% of Americans live at least a 4-hour drive from a proton beam therapy facility.
- Those who are older, live in rural areas or live below the poverty line often must travel farthest.
More than 16% of Americans live at least a 4-hour drive from the closest proton beam therapy facility, according to data published in JAMA Network Open.
Older adults, those with lower incomes and those who live in rural areas often face the longest commutes.
“These disparities present a barrier to an emerging technology in cancer treatment and inhibit equitable access to ongoing clinical trials,” Todd Burus, MAS, researcher at University of Kentucky Markey Cancer Center’s community impact office, said in a press release.
Proton beam therapy — a relatively newer radiotherapy treatment for certain patients with cancer — often confers comparable efficacy to traditional photon-based therapy; however, the modality can greatly reduce the radiation dose to healthy surrounding tissue.
Burus and colleagues conducted a population-based cross-sectional study to characterize the distribution of proton beam therapy facilities across the United States and determine if inequities in drive-time access existed for certain populations.
Researchers measured census tract variables in the contiguous United States between 2017 and 2021. They measured drive time to the nearest proton therapy facility. They also used the American Community Survey to determine whether factors such as race, ethnicity, age, insurance status, income or urbanicity appeared associated with travel time.
Researchers characterized “poor access” to proton facilities as a 4-hour or longer drive from the nearest location.
The analysis included more than 327 million U.S. residents (59.6% non-Hispanic white, 18.5% Hispanic, 12.3% non-Hispanic Black, 5.5% non-Hispanic Asian; 86.1% residing in urban counties).
Median drive time to the nearest facility was 96.1 minutes (interquartile range, 39.6-195.3).
About one-third (36.6%) of residents lived within 1-hour of the nearest proton facility. In contrast, 16.4% of residents had at least a 4-hour commute.
Non-Hispanic white individuals had the longest commute (median, 109.8 minutes; interquartile range, 48-197.6), followed by Hispanic (median, 76.9 minutes; interquartile range, 33.1-201.1), non-Hispanic Black (median, 63.3 minutes; interquartile range, 29.5-172.2) and non-Hispanic Asian individuals (median, 61 minutes; interquartile range, 30-194.2).
Multivariable analysis showed factors associated with a commute longer than 4 hours included rurality (OR = 2.45; 95% CI, 2.27-2.64), age 65 years or older (OR = 1.09; 95% CI, 1.06-1.11) and living below the poverty line (OR = 1.22; 95% CI, 1.2-1.25).
Researchers acknowledged study limitations, including the assumption that patients would travel to the closest facility, calculating travel time via personal vehicle transportation and not taking into account other modes of transportation, not accounting for other racial or ethnic groups due to their absence in many census tracts, and a potential underestimation of geographic access for pediatric patients.
“These results have broad and important ramifications for patients, radiation oncology clinicians, researchers, cancer center administrators and policy makers,” Burus and colleagues wrote. “Being aware of drive-time requirements may also improve shared decision making for clinicians and patients when considering [proton beam therapy] as a potential treatment option.”
References:
- Burus T, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.10670.
- Markey study finds gaps in access to proton beam therapy (press release). Available at: https://uknow.uky.edu/research/markey-study-finds-gaps-access-proton-beam-therapy. Published July 29, 2024. Accessed Aug. 7, 2024.
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Burus T, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.10670.
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