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Description

Cancer is the second leading cause of mortality in the United States and it is estimated that 50% of all people diagnosed with cancer require radiotherapy as part of their treatment. Shorter radiation courses, or hypofractionation, use larger doses per fraction, reducing the overall duration of a radiotherapy course. In this study, we investigate whether there are currently disparities in hypofractionation delivery to underserved populations that would influence withholding novel payment policies catered to supporting these patients. We hypothesize that cancer patients from racially and ethnically minoritized, rural, and low socioeconomic backgrounds are less likely to receive hypofractionated radiotherapy than other populations. The Centers for Medicare and Medicaid Services (CMS) claims data from 2016-2018 was used for patients treated with radiotherapy for any of 14 cancers included in a proposed novel payment model, the Radiation Oncology Model. Models were then created from the 14 cancer types we analyzed over 4 exposure levels. We found that minority and low socioeconomic status (SES) patients were just as likely to receive hypofractionated radiotherapy across most cancer types, compared to high socioeconomic status patients. These findings suggest an urgent need for value-based payment models like the Radiation Oncology Model, which incentivizes hypofractionation. Limitations of the study were that the study had a retrospective nature with a focus on the data and models occurring before 2018. Future studies should look into the potential faults in the current fee-for-service (FFS) payment model.

Publication Date

4-1-2025

Keywords

cancer treatment, radiotherapy, hypofractionation, healthcare disparities, underserved populations, racial and ethnic minorities, rural healthcare, socioeconomic status, value-based care, Radiation Oncology Model, CMS claims data, healthcare equity, novel payment models, fee-for-service, radiation oncology, health policy, cancer disparities, Medicare and Medicaid, retrospective study

Disparities in Delivery of Hypofractionated Radiotherapy in Underserved Populations

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