Race And Income Inequity In Receipt Of Aggressive Palliative Radiotherapy

Over the past decade expanding systemic therapy options and emerging evidence for aggressive treatment of oligometastatic disease have expanded the role of palliative radiotherapy (PRT). It is unknown whether aggressive management has been equitable for all patients. We hypothesized patients from non-white racial backgrounds were less likely to receive aggressive PRT. We performed a retrospective analysis of all PRT courses at our institution from 1/2008-2/2020. For each PRT course we recorded year of treatment, age, gender, race (white vs. non-white), and ZIP code of record, which was used to determine distance from treatment center and income level according to US census median income level data. We performed logistic regression modeling to determine whether these factors were associated with receipt of aggressive PRT, which we defined as palliative stereotactic body radiotherapy (SBRT) or any course numbered three or higher (C3+). 9971 individual PRT courses were included for analysis, of which 68% were delivered to white and 32% to non-white patients. Among C3+ courses (n = 2377), 72% were delivered to white and 28% to non-white patients. Among SBRT courses (n = 877), 80% were delivered to white and 20% to non-white patients. Logistic regression results are shown in Table 1. Aggressive PRT was more likely in recent years. Non-white and low-income patients were less likely to receive aggressive PRT with non-white race having a lower odds ratio (OR) for both C3+ (OR 0.80, p<0.001) and SBRT (OR 0.66, p<0.001). Older patients were less likely to receive C3+ (OR 0.91, p<0.001) but more likely to receive SBRT (OR 1.11, P<0.001). Based on our large single-institution experience, significant disparities exist in the receipt of aggressive PRT, with non-white and low-income patients significantly less likely to receive any aggressive PRT when controlling for confounding variables. This is especially true for patients from non-white backgrounds. These hypothesis-generating trends warrant further investigation and determination of primary histology, stage at diagnosis, prior definitive therapy courses, and which SBRT courses represented re-irradiation of a previously treated lesion, as well and insurer of record to see if payer is predictive of aggressive management. Next steps will include expanding available variables in our large database and collaborative efforts to achieve equitable access within our institution.Tabled 1Abstract 2884; Table CI – confidence intervalC3+SBRTORCIp-valueORCIp-valueCourse 1 or 2---0.910.78–1.070.255Year1.121.10–1.14<0.0011.131.10–1.16<0.001Age (decade)0.910.88–0.95<0.0011.111.05–1.17<0.001Non-white race0.800.71–0.90<0.0010.660.54–0.80<0.001Distance (decile)1.000.98–1.010.6111.051.02–1.08<0.001Income (quartile)1.091.04–1.140.0011.171.09–1.26<0.001Female gender0.780.71–0.86<0.0011.100.96–1.270.179 Open table in a new tab