Inequality in Delivery of Palliative Radiotherapy Among Black Patients With Cancer and Elderly With Comorbidities  

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An analysis of data from more than 51,000 patients with stage IV cancer shows “significant inequality” in the delivery of palliative radiotherapy among the elderly, patients with comorbidity, and black patients with prostate and colorectal cancer, reported James D. Murphy, MD, MS, and colleagues from Stanford University School of Medicine and the University of California, in the Journal of Oncology Practice.

The Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database was used to identify patients with the four most commonly diagnosed cancers in the United States: breast, prostate, non–small cell lung, and colorectal cancers. The patients were diagnosed between 2000 and 2007 and observed through 2009. Among the 51,610 patients identified, 21,279 (41%) received palliative radiotherapy; 54% of patients with lung cancer, 42% of patients with breast cancer, 40% of patients with prostate cancer, and 12% of patients with colorectal cancers.

“Across all disease sites, multivariate analysis showed that older patients (P < .001) and those with high comorbidity scores (P < .001) were less likely to receive palliative [radiotherapy],” the investigators found. Older persons also had slightly shorter courses of radiation, an average of 1.3 days shorter for every 10 years older (P < .001).

“Black patients with prostate cancer were 20% less likely (P < .001), and black patients with colorectal cancer were 28% less likely (P < .001), than white patients to receive palliative [radiotherapy],” the researchers reported. No significant differences between black and white patients were noted for breast or lung cancer.

There were higher rates of palliative radiotherapy for lung, breast, and prostate cancer in higher socioeconomic classes and among people who were married. “The use of palliative [radiotherapy] decreased slightly over time for lung cancer and remained relatively stable for breast, prostate, and colorectal cancers,” the investigators reported. 

The authors also observed that a significant proportion of patients received radiotherapy shortly before death. “Specifically, 23% of patients with lung cancer died within 2 weeks of completing palliative [radiotherapy], followed by those with colorectal (12%), breast (12%), and prostate cancers (8%).” Other significant predictors (P < .05) of death within 2 weeks of radiotherapy included increased age, increased comorbidity, and male sex. ■

Murphy JD, et al: J Oncol Pract 9:e220-e227, 2013.




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