Disparities/Minority Health

Poorer patients less likely to receive specific treatment for head and neck cancer

Radiation therapy remains an important treatment modality for patients with head and neck cancers. Earlier radiotherapy techniques caused a variety of toxicities and damaging effects to surrounding tissues. Today, intensity-modulated radiotherapy (IMRT) reduces many of these risks while providing good treatment results. While IMRT has become more widely available, not all patients are receiving its benefits. A new study finds that patients in the lowest socioeconomic quartile are less likely to receive this treatment compared with more affluent patients.

Researchers used information from a Medicare-linked database on 5,487 patients diagnosed with head and neck cancers from 2000 to 2005. Twelve diverse geographic areas were represented, including urban and rural areas. Using diagnostic and procedure codes, the researchers determined who received IMRT, another type of radiotherapy, surgery, or other treatment. Patients were also categorized according to age, gender, race, marital status, and tumor characteristics. Between 2000 and 2005, 21.3 percent of patients with head and neck cancers received IMRT.

Each year, the number of patients treated with IMRT increased significantly. For example, patients diagnosed in 2003 were 20 times more likely to receive IMRT compared with those diagnosed in 2000. This likelihood more than tripled by 2005. Patients in the poorest socioeconomic category were less likely to receive IMRT (18.6 percent) than patients in the highest socioeconomic category (22.1 percent). Patients aged 80 and older were less likely to receive IMRT (16.8 percent) compared with patients aged 65 to 69 years (25.1 percent). Among geographic regions, Hawaii (40.4 percent), Utah (33.3 percent), and Atlanta/rural Georgia (30.0 percent) had the highest percentage of patients receiving IMRT. Areas with the lowest rates of IMRT use were Kentucky (11.3 percent), Detroit (16.5 percent), and Connecticut (17.6 percent). The highest rates of IMRT were found for patients with tumors of the nasopharynx (29.6 percent) and oropharynx (25.1 percent). The study was supported in part by the Agency for Healthcare Research and Quality (HS16743).

See "Evaluation of trends in the use of intensity-modulated radiotherapy for head and neck cancer from 2000 through 2005," by B. Ashleigh Guadagnolo, M.D., M.P.H., Chih-Chin Liu, M.S., Janice N. Cormier, M.D., M.P.H., and Xianglin L. Du, M.D., Ph.D., in the July 15, 2010, Cancer 116, pp. 3505-3512.

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