The number of clinics and private radiation therapy facilities continues to grow across the country, yet 5 percent of patients must still drive almost an hour for treatment, researchers shared at the ASTRO 2020 Annual Meeting (Abstract 203).
A paper presented by Sean Maroongroge, MD, MBA, a radiation oncology resident at the University of Texas MD Anderson Cancer Center in Houston, showed 1 in 20 patients still live more than 50 miles from the nearest radiotherapy facility. This is explained in part by the fact that the growth in the number of centers has occurred near urban areas where such care is already near.
"One in 20 Americans lives quite far from a radiation therapy clinic," said Maroongroge, lead author of the study. "If we do not incentivize or find ways to help people who live farther from treatment sites get access to radiation therapy, then this gap may continue to widen over time," he said.
Up to two-thirds of individuals diagnosed with cancer receive radiation therapy, generally over multiple sessions that can require daily trips for several weeks, he noted. "With the growth of telemedicine, especially during the COVID-19 pandemic, there are a lot of ways we can think about transforming care, but radiation therapy delivery requires patients to come to a treatment facility."
In 2020, a total of 2,332 U.S. radiation facilities were reported compared to 1,987 in 2005, a growth rate of 17 percent. Research clearly shows that geographic access plays a major role in clinical care that must be delivered in daily sessions over a period of time, Maroongroge noted.
"Longer travel times for cancer treatment can negatively impact patients' clinical outcomes, quality of life, and likelihood of finishing treatment without interruption. People who live far from a radiation therapy facility are substantially less likely to receive radiation, and this can lead to unnecessarily aggressive treatment plans, such as a patient with early-stage breast cancer receiving mastectomy when breast-conserving surgery with radiation is an established standard of care," he said.
Maroongroge and his colleagues analyzed state regulatory data to update a database of radiation therapy clinic locations originally developed in 2005. Facilities that were active between 2018 and 2020 were mapped and compared with those in the original database. They found radiation therapy facilities have grown by 17 percent from 1,987 sites in 2005 to 2,332 sites in 2020, and that about 70 percent of the population lives within 12.5 miles of a treatment facility.
"The growth in the number of facilities is not surprising, from a medical perspective. As patients and other physicians increasingly appreciate the value of radiation, we expect to see more centers built and more existing centers include radiation therapy," noted Maroongroge.
The rate of growth was faster for people living closest to facilities (within 12.5 miles, from 65.4% to 69.6%) than it did for those farther away (within 50 miles, from 94.6% to 95.5%). However, this means that 4.5 percent of the population remains more than 50 miles from the nearest facility.
"The most unfortunate cases I see are when nonclinical factors undermine the type of care patients receive," Maroongroge continued. "I have patients who just say that it's just not feasible for them to get radiation if they have to travel a long distance. The financial stress and the weight of logistical burdens can't be understated in terms of how much they dominate patients' lives."
While reasons behind the trends were beyond the scope of the current study, other research has pointed to substantial overhead costs and changing provider preference as two potential factors in disproportionate growth.
"There are a lot of questions in terms of policy and perhaps even technology that may help us deliver better care to underserved patients," he said.
Sex & Survivorship
Another study presented at the meeting, a survey of almost 400 cancer survivors of all types, underscored the need for oncologists to start asking many more patients about their sexual health after chemotherapy, radiation, and other treatment (Abstract 1042).
A survey of 400 survivors found almost 90 percent of respondents reported some sexual side effects from treatment, but most said their oncologist had not asked them about the subject. Women were especially unlikely to be asked about sexual dysfunction, reported James Taylor, MD, MPH, Chief Resident in Radiation Oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia.
"Sexual dysfunction is an unfortunate side effect of cancer treatment, and there appears to be a large gender disparity in how physicians discuss sexual health with patients," Taylor told a press conference. "Our results show that we are asking men about sexual dysfunction caused by cancer treatment, but we are not asking women as frequently. We should be asking everyone to determine how we can help."
Research has shown that sexual side effects or those that affect desire or libido are closely linked with cancer survivors' quality of life, he continued. Potential issues include erectile dysfunction with prostate cancer treatment or vaginal dryness with gynecological cancer treatment. Others experience emotional and/or mental challenges, such as body dysmorphia after mastectomy or decreased sexual desire with hormone therapy.
Methodology
The study involved 3,912 responses to an electronic survey about sexual side effects after cancer treatment, 81 percent of them female. The most common cancer types were breast (67%), prostate (16%), and endometrial (6%) cancers. Treatments included chemotherapy (78%), radiation therapy (54%), and hormone therapy (47%).
Fully 87 percent of the respondents reported that treatment had negatively impacted their sexual health and quality of life. The most common side effects were painful intercourse (73%), body image distortion (54%), and inability to achieve orgasm (42%). Less than one half of respondents (44%) said they had been counseled preemptively that treatment might affect their sexual health.
"We were surprised at how infrequently sexual health and potential side effects of cancer treatment are discussed with female patients, especially compared to male patients," said Taylor.
Half of respondents said they would be most comfortable if the discussion was initiated by their provider and guided by a standard questionnaire on possible side effects that included sexual side effects.
"Patients seem to prefer completing a survey or questions about their sexual health in clinic and then reviewing this information with their provider, rather than the physician directly asking the patient or the patient driving the discussion," Taylor noted. "A questionnaire administered to all patients can reduce uncomfortable feelings and make bridging the discussion much easier. We know that validated instruments exist, and it is time to put them into practice."
Because participants largely self-selected into the survey via social media, Taylor acknowledged that response bias may have influenced the high rates of sexual side effects.
Kurt Samson is a contributing writer.