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Demographic Disparities in SBRT Utilization for Stage I NSCLC
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Volume 90 Number 1S Supplement 2014 in patients with extensive stage small cell lung cancer (SCLC). Our study aims to evaluate the uptake of PCI and its impact on the survival of extensive stage SCLC patients before and after publication of this randomized trial. Materials/Methods: We used our institution pathology registry to identify patients diagnosed with extensive stage SCLC without brain metastases and treated with palliative intent from 2003 to 2010. We linked the electronic records of treatment to the National Death Registry. We described the utilization of PCI and compared survival of all patients diagnosed from 2003 to 2006 with patients diagnosed from 2007 to 2010. Results: Eighty-six patients were identified. The demographics and treatment characteristics were similar between the two cohorts save for the earlier cohort having a lower Charlson’s comorbidity index and the uptake of PCI increased from 6% (3 of 50 patients, 2003 to 2006) to 28% (10 of 36 patients, 2007 to 2010). All patients receiving PCI responded to first line chemotherapy and had 4 or more cycles. There was a significant improvement in 1-year survival from 14% (2003 to 2006) to 33% (2007 to 2010; P Z 0.018). Patients with improved overall survival were more likely to have lower Charlson’s comorbidity score, received chemotherapy and PCI. Conclusions: Since 2007, there has been an increase in adoption of PCI for extensive stage SCLC, which may be associated with significant improvement in survival in the later cohort. A population based outcome study to validate this observation is warranted. Author Disclosure: Y. Soon: None. E. Loy: None. B. Vellayappan: None. I. Tham: None.
2925 Referral Patterns for Pediatric Proton Therapy in Florida N.N. Paryani, D.J. Indelicato, R.L. Rotondo, J.A. Bradley, E. Sandler, P. Aldana, and N.P. Mendenhall; University of Florida Proton Therapy Institute, Jacksonville, FL Purpose/Objective(s): With increasing evidence supporting the use of proton therapy in pediatric tumors, the number of children in the US treated with protons increased by 33% between 2010 and 2012. Currently the third largest state in the US, Florida is served by a single proton therapy center and thus provides a unique setting to examine resource utilization and factors influencing referral. Materials/Methods: 5,085 patients aged 0 to 21 years were registered in the Florida Association of Pediatric Tumor Programs (FAPTP) state cancer database between January 2007 and August 2013, which contains publicly available data on patient age, ethnicity, insurance status, and histology. Of these patients, 3,119 had diagnoses for which proton therapy would not be indicated and 28 had incomplete information, leaving 1,938 patients with diagnoses for which proton therapy might be indicated. Estimates of the percentage of patients medically eligible for proton therapy were derived from the Central Brain Tumor Registry of the United States and published literature and then compared with the number of patients over the same time period actually referred to the University of Florida Proton Therapy Institute (UFPTI) for treatment. Results: Over the past 5 years, only 181 of the 747 (24%) children in Florida registered in FAPTP and estimated to be medically eligible for proton therapy were referred to UFPTI (Table). All medically eligible patients were accepted for treatment. In the FAPTP estimate, median age was 10 years, 55% were male, and 70% were white, whereas in the proton therapy referrals, median age was 8 years, 50% were male, and 80% were white. In the FAPTP estimate, 39% of patients had commercial insurance, 34% were enrolled in Medicaid, and 27% were enrolled in CMS or uninsured compared with 63%, 43%, and 8%, respectively, in the proton therapy referrals. Conclusions: This is the first state-wide study of its type and suggests that proton therapy is underutilized in Florida’s pediatric patients. In particular, children who lack commercial insurance appear to be less likely to be referred for proton therapy, likely reflecting socioeconomic barriers to travel and relocation.
Scientific Abstract 2925; Table Distribution of Eligible Pediatric Patients Referred for Proton Therapy in Florida
ICD-0-3 Diagnosis Medulloblastoma/PNET Rhabdomyosarcoma Other brain tumors Ewing sarcoma Hodgkin lymphoma Osteosarcoma Neuroblastoma Retinoblastoma Total
Total diagnosed in Florida (2007-2013) 49 158 916 125 291 163 140 96 1938
Number (%) % of eligible expected to Number patients receive referred referred radiation for proton for proton therapy therapy therapy 44 111 366 44 102 5 70 5 747
(90%) (70%) (40%) (35%) (35%) (3%) (50%) (5%) (39%)
27 20 103 16 14 1 0 0 181
61% 18% 28% 36% 14% 20% 0% 0% 24%
Author Disclosure: N.N. Paryani: None. D.J. Indelicato: None. R.L. Rotondo: None. J.A. Bradley: None. E. Sandler: None. P. Aldana: None. N.P. Mendenhall: None.
2926 Demographic Disparities in SBRT Utilization for Stage I NSCLC C.D. Corso, H.S. Park, A.C. Moreno, A.W. Kim, J.B. Yu, Z. Husain, and R.H. Decker; Yale University School of Medicine, New Haven, CT Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) is being increasingly utilized in the treatment of patients with Stage I NSCLC. However, whether this technology is being utilized equitably has not previously been analyzed. In this study, we sought to investigate demographic factors that are predictive of treatment with this emerging technique. Materials/Methods: The National Cancer Database (NCDB), was queried to identify adult patients aged 19 with a clinical diagnosis of Stage I NSCLC (cT1-2N0M0) between 2003 and 2011. Patients were separated into groups based on primary treatment including surgery (lobectomy or sublobectomy), SBRT, non-SBRT radiation therapy, and no treatment. Univariate analysis was performed using the chi-square test and multivariate analysis was performed with a binary logistic regression model that adjusted for patient age, sex, year of diagnosis, morbidity score, race, Hispanic origin, distance to the treating facility, income level of the reported zip code, education level of the reported zip code, and urban/rural setting. Results: A total of 117,119 patients met the inclusion criteria. The average age for all Stage I patients was 69.7 years. The primary intervention was surgical resection in 65% of patients, SBRT in 6%, EBRT in 15%, and no local therapy in 13%. On average, patients treated with SBRTwere older than those treated with surgery (74.3 vs 67.7 yrs, p<0.01). Univariate analysis demonstrated that age, race, sex, year of diagnosis, income, education, distance to hospital, clinical stage, and co-morbid illness were all significant factors (p<0.05). Multivariate logistic regression found older age (HR 2.77, CI 2.57-2.97), Black race (HR 1.31, CI 1.17-1.47), year of diagnosis (HR 1.40, CI 1.38-1.43), wealthier zip code (HR 1.10, CI 1.01-1.20) and greater travel distance (HR 1.29, CI 1.20-1.39) were significant predictors of treatment with SBRT over surgery. Negative predictive factors included nonBlack racial minority (HR 0.60, CI 0.45-0.79), Hispanic ethnicity (HR 0.64, CI 0.42-0.97), multiple co-morbidities (HR 0.65, CI 0.61-0.70), and Stage IB disease (HR 0.79, CI 0.73-0.85). A multivariate analysis comparing SBRT to no local therapy found similar predictive variables as above, except that Black race was a negative predictor for SBRT (HR 0.81, CI 0.71-.0.93) as was non-Black racial minority and Hispanic ethnicity. Conclusions: We observed that in this data set Black patients were more likely to receive SBRT than surgery, but less likely to receive SBRT than no local therapy after adjusting for demographic and clinical factors. Patients of non-Black racial minority and Hispanic origin were less likely to receive SBRT than surgery or no local therapy. These findings may represent less aggressive treatment in Black patients and decreased access to SBRT therapy in all minority groups. Author Disclosure: C.D. Corso: None. H.S. Park: None. A.C. Moreno: None. A.W. Kim: None. J.B. Yu: None. Z. Husain: None. R.H. Decker: None.
Volume 90 Number 1S Supplement 2014 in patients with extensive stage small cell lung cancer (SCLC). Our study aims to evaluate the uptake of PCI and its impact on the survival of extensive stage SCLC patients before and after publication of this randomized trial. Materials/Methods: We used our institution pathology registry to identify patients diagnosed with extensive stage SCLC without brain metastases and treated with palliative intent from 2003 to 2010. We linked the electronic records of treatment to the National Death Registry. We described the utilization of PCI and compared survival of all patients diagnosed from 2003 to 2006 with patients diagnosed from 2007 to 2010. Results: Eighty-six patients were identified. The demographics and treatment characteristics were similar between the two cohorts save for the earlier cohort having a lower Charlson’s comorbidity index and the uptake of PCI increased from 6% (3 of 50 patients, 2003 to 2006) to 28% (10 of 36 patients, 2007 to 2010). All patients receiving PCI responded to first line chemotherapy and had 4 or more cycles. There was a significant improvement in 1-year survival from 14% (2003 to 2006) to 33% (2007 to 2010; P Z 0.018). Patients with improved overall survival were more likely to have lower Charlson’s comorbidity score, received chemotherapy and PCI. Conclusions: Since 2007, there has been an increase in adoption of PCI for extensive stage SCLC, which may be associated with significant improvement in survival in the later cohort. A population based outcome study to validate this observation is warranted. Author Disclosure: Y. Soon: None. E. Loy: None. B. Vellayappan: None. I. Tham: None.
2925 Referral Patterns for Pediatric Proton Therapy in Florida N.N. Paryani, D.J. Indelicato, R.L. Rotondo, J.A. Bradley, E. Sandler, P. Aldana, and N.P. Mendenhall; University of Florida Proton Therapy Institute, Jacksonville, FL Purpose/Objective(s): With increasing evidence supporting the use of proton therapy in pediatric tumors, the number of children in the US treated with protons increased by 33% between 2010 and 2012. Currently the third largest state in the US, Florida is served by a single proton therapy center and thus provides a unique setting to examine resource utilization and factors influencing referral. Materials/Methods: 5,085 patients aged 0 to 21 years were registered in the Florida Association of Pediatric Tumor Programs (FAPTP) state cancer database between January 2007 and August 2013, which contains publicly available data on patient age, ethnicity, insurance status, and histology. Of these patients, 3,119 had diagnoses for which proton therapy would not be indicated and 28 had incomplete information, leaving 1,938 patients with diagnoses for which proton therapy might be indicated. Estimates of the percentage of patients medically eligible for proton therapy were derived from the Central Brain Tumor Registry of the United States and published literature and then compared with the number of patients over the same time period actually referred to the University of Florida Proton Therapy Institute (UFPTI) for treatment. Results: Over the past 5 years, only 181 of the 747 (24%) children in Florida registered in FAPTP and estimated to be medically eligible for proton therapy were referred to UFPTI (Table). All medically eligible patients were accepted for treatment. In the FAPTP estimate, median age was 10 years, 55% were male, and 70% were white, whereas in the proton therapy referrals, median age was 8 years, 50% were male, and 80% were white. In the FAPTP estimate, 39% of patients had commercial insurance, 34% were enrolled in Medicaid, and 27% were enrolled in CMS or uninsured compared with 63%, 43%, and 8%, respectively, in the proton therapy referrals. Conclusions: This is the first state-wide study of its type and suggests that proton therapy is underutilized in Florida’s pediatric patients. In particular, children who lack commercial insurance appear to be less likely to be referred for proton therapy, likely reflecting socioeconomic barriers to travel and relocation.
Scientific Abstract 2925; Table Distribution of Eligible Pediatric Patients Referred for Proton Therapy in Florida
ICD-0-3 Diagnosis Medulloblastoma/PNET Rhabdomyosarcoma Other brain tumors Ewing sarcoma Hodgkin lymphoma Osteosarcoma Neuroblastoma Retinoblastoma Total
Total diagnosed in Florida (2007-2013) 49 158 916 125 291 163 140 96 1938
Number (%) % of eligible expected to Number patients receive referred referred radiation for proton for proton therapy therapy therapy 44 111 366 44 102 5 70 5 747
(90%) (70%) (40%) (35%) (35%) (3%) (50%) (5%) (39%)
27 20 103 16 14 1 0 0 181
61% 18% 28% 36% 14% 20% 0% 0% 24%
Author Disclosure: N.N. Paryani: None. D.J. Indelicato: None. R.L. Rotondo: None. J.A. Bradley: None. E. Sandler: None. P. Aldana: None. N.P. Mendenhall: None.
2926 Demographic Disparities in SBRT Utilization for Stage I NSCLC C.D. Corso, H.S. Park, A.C. Moreno, A.W. Kim, J.B. Yu, Z. Husain, and R.H. Decker; Yale University School of Medicine, New Haven, CT Purpose/Objective(s): Stereotactic body radiation therapy (SBRT) is being increasingly utilized in the treatment of patients with Stage I NSCLC. However, whether this technology is being utilized equitably has not previously been analyzed. In this study, we sought to investigate demographic factors that are predictive of treatment with this emerging technique. Materials/Methods: The National Cancer Database (NCDB), was queried to identify adult patients aged 19 with a clinical diagnosis of Stage I NSCLC (cT1-2N0M0) between 2003 and 2011. Patients were separated into groups based on primary treatment including surgery (lobectomy or sublobectomy), SBRT, non-SBRT radiation therapy, and no treatment. Univariate analysis was performed using the chi-square test and multivariate analysis was performed with a binary logistic regression model that adjusted for patient age, sex, year of diagnosis, morbidity score, race, Hispanic origin, distance to the treating facility, income level of the reported zip code, education level of the reported zip code, and urban/rural setting. Results: A total of 117,119 patients met the inclusion criteria. The average age for all Stage I patients was 69.7 years. The primary intervention was surgical resection in 65% of patients, SBRT in 6%, EBRT in 15%, and no local therapy in 13%. On average, patients treated with SBRTwere older than those treated with surgery (74.3 vs 67.7 yrs, p<0.01). Univariate analysis demonstrated that age, race, sex, year of diagnosis, income, education, distance to hospital, clinical stage, and co-morbid illness were all significant factors (p<0.05). Multivariate logistic regression found older age (HR 2.77, CI 2.57-2.97), Black race (HR 1.31, CI 1.17-1.47), year of diagnosis (HR 1.40, CI 1.38-1.43), wealthier zip code (HR 1.10, CI 1.01-1.20) and greater travel distance (HR 1.29, CI 1.20-1.39) were significant predictors of treatment with SBRT over surgery. Negative predictive factors included nonBlack racial minority (HR 0.60, CI 0.45-0.79), Hispanic ethnicity (HR 0.64, CI 0.42-0.97), multiple co-morbidities (HR 0.65, CI 0.61-0.70), and Stage IB disease (HR 0.79, CI 0.73-0.85). A multivariate analysis comparing SBRT to no local therapy found similar predictive variables as above, except that Black race was a negative predictor for SBRT (HR 0.81, CI 0.71-.0.93) as was non-Black racial minority and Hispanic ethnicity. Conclusions: We observed that in this data set Black patients were more likely to receive SBRT than surgery, but less likely to receive SBRT than no local therapy after adjusting for demographic and clinical factors. Patients of non-Black racial minority and Hispanic origin were less likely to receive SBRT than surgery or no local therapy. These findings may represent less aggressive treatment in Black patients and decreased access to SBRT therapy in all minority groups. Author Disclosure: C.D. Corso: None. H.S. Park: None. A.C. Moreno: None. A.W. Kim: None. J.B. Yu: None. Z. Husain: None. R.H. Decker: None.