Presentation 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. A conventional course of radiotherapy, delivered through individual doses called fractions, could take up to 8 weeks to deliver in full. 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 15 cancers included in a proposed novel payment model, the Radiation Oncology Model. Data on radiation fractions was collected from the first round of radiation and stopped at a break in radiation fractions for more than 14 days. Models were then created from the 15 cancer types we analyzed over 4 exposure levels. We found that minority and low socioeconomic status (SES) patients were less likely to receive hypofractionated radiotherapy across all cancer types, compared to high socioeconomic status patients. This disparity suggests 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.