From 2004 to 2020, there was an increase in the use of shorter radiotherapy (RT) courses (hypofractionation) for prostate cancer, according to a brief report published online Oct. 5 in JAMA Oncology.
James B. Yu, ddavp esrd M.D., from St. Francis Hospital in Hartford, Connecticut, and colleagues used data from the National Cancer Database to identify the current practice patterns of external beam RT for prostate cancer in the United States. The analysis included 313,062 patients with localized prostate cancer.
The researchers identified a significant temporal pattern of decline in the proportion of patients who received conventional fractionation from 2004 to 2020 (76.0 to 36.6 percent). During the same period, use of moderate hypofractionation and ultrahypofractionation significantly increased (from 22.0 to 45.0 percent and from 2.0 to 18.3 percent, respectively).
For patients in the low- and intermediate-risk groups, the most common RT schedule by 2020 was ultrahypofractionation and moderate hypofractionation, respectively. Shorter courses of RT were seen in association with treatment at a community cancer program versus academic or research program, Medicaid versus Medicare insurance, Black versus White race, and higher versus lower median income.
“Reduced adoption was associated with multiple social determinants of health,” the authors write. “Realignment of value-based models to appropriately increase reimbursement for hypofractionation may reduce barriers to nationwide adoption and may ensure access to this treatment for underserved communities.”
Several authors disclosed ties to the pharmaceutical industry.
James B. Yu et al, Increasing Use of Shorter-Course Radiotherapy for Prostate Cancer, JAMA Oncology (2023). DOI: 10.1001/jamaoncol.2023.4267
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