The past 15 years have seen an increase in the number of radiotherapy facilities in the United States (up by 17%), but they are still disproportionately located in urban areas that already have an ample supply of centers, according to the results of a new study.
The researchers estimated that about 70% of the US population now live within 12.5 miles of a facility offering radiotherapy. However, approximately 4.5% remain more than 50 miles from the nearest center.
Access to radiotherapy is important, explained lead author Sean Maroongroge, MD, MBA, a radiation oncology resident at the University of Texas MD Anderson Cancer Center in Houston.
"Radiation therapy is a key part of the treatment paradigm for most patients with cancer," he said. "It's also unique among cancer modalities in that patients need to come back for multiple treatments."
Some patients may need to return for daily treatments for up to 7 weeks, which magnifies the importance of the distance that must be traveled for treatment. The distance from radiotherapy facilities is correlated with the receipt of radiotherapy, Maroongroge noted.
A patient will have to take into consideration travel to and from the radiotherapy facility when choosing which treatment to opt for, he added. For example, a patient with breast cancer could choose between a mastectomy or breast-conserving surgery plus radiotherapy, and a patient with prostate cancer could choose between definitive radiotherapy or a prostatectomy.
"Distance also affects clinical trial participation," he said.
Geographic Disparities Persist
The last comprehensive inventory of US radiotherapy facilities was conducted in 2005. Maroongroge and colleagues updated this database to evaluate changes that have taken place over the past 15 years.
To update the database, the authors used data from state regulatory agencies, such as health departments, as well as from national dosimetry monitoring organizations. They also used information from two independent peer review organizations, Radiation Dosimetry Services and the Imaging and Radiation Oncology Core. These organizations provide nationwide dosimetry auditing for radiotherapy units.
The number of treatment facilities grew from 1987 sites in 2005 to 2332 sites in 2020, an increase of 17%.
"But surprisingly, 33% of the sites in our initial database from 2005 did not exist in our updated database," he pointed out. "But this may reflect methodologic circumstances."
The rate of growth increased faster in areas where people lived closest to facilities than it did in areas where people lived farther away. The percentage of the population living <12.5 or <25 miles from a facility (ie, those with greater access) increased faster than it did for people living <50 miles to away.
The findings are consistent with recent reports of substantial variation in the geographic distribution of radiation oncologists.
Maroongroge noted that these findings raise a question as to whether resources are being allocated appropriately. "Do we need to do more to actually increase access for patients located furthest away from treatment centers?," he asked.
This is the most complete database on radiotherapy facilities in the United States, he concluded. He noted that there will be "future opportunities to use these data to better understand underserved US populations."
This study highlights the challenge of radiotherapy for rural populations, commented an expert not involved in the study. "We do need to spend time understanding the social determinants of health and the conditions in which patients live, work, and play," said Karen Winkfield, MD, PhD, executive director of the Meharry-Vanderbilt Alliance, Nashville, Tennessee.
Maroongroge has disclosed no relevant financial relationships.
American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting: Abstract 203. Presented October 27, 2020
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Cite this: Increase in Radiation Facilities in US, but Most in Urban Areas - Medscape - Nov 06, 2020.