S. P. Collins1, A. McGovern2, K. Morris2, R. Hankins1, and J. B. Yu3; 1MedStar Georgetown University Hospital, Washington, DC, 2Boston Scientific, Marlborough, MA, 3Smilow Cancer Hospital, Hartford, CT
Purpose/Objective(s): Previous research has examined the impact of socioeconomic factors, such as income and geographic location, on prostate cancer treatment and outcomes. However, their influence on rectal spacer utilization in prostate cancer patients remains largely unexplored. This analysis aims to investigate the relationship between median household income (MHI), geography, and rectal spacer utilization among prostate cancer patients. Materials/
Methods: The Medicare 5% Standard Analytical Files were used to identify men aged 65+ diagnosed with prostate cancer between 1/1/2017 and 12/31/2021. Patients who received intensity-modulated radiotherapy, stereotactic body radiation, brachytherapy, or proton therapy post-prostate cancer diagnosis were included. Patients were required to have continuous Medicare fee-for-service enrollment for at least 3 years pre- and 1 year post-index treatment date. Men who had a radical prostatectomy within the pre-index period or who were diagnosed with any non-prostate cancer malignant neoplasm during the study period were excluded. Eligible patients were stratified based on the placement of a rectal spacer within 60 days before their index treatment date. County-level 2022 MHI data from the United States (US) Census Bureau Small Area Income and Poverty Estimates dataset was cross-matched with patient county codes to classify patients into income quintiles (Q1: =$50,533, Q2: $50,534-$57,495, Q3: $57,496-$64,037, Q4: $64,038-$73,429, Q5: =$73,430). Results: A total of 66,680 prostate cancer patients who received radiation therapy were identified, with a mean age of 72.8 years and a mean Charlson comorbidity score of 3.26. Most patients were White (80.7%) and lived in the Southern region (38.9%) of the US. Among them, 17,940 (26.9%) received a rectal spacer. Spacer utilization varied by region, with the highest proportion of patients in the West receiving a spacer (31.7%) and the lowest in the Northeast (23.6%). The top three states with the highest proportion of spacer utilization were Utah (68.2%), Louisiana (51.9%), and Oklahoma (50.0%). White identified patients were significantly more likely than Black identified patients to receive a spacer in all regions except the Northeast, where Black identified patients were significantly more likely than White identified patients to receive a spacer (all p<0.001). Higher MHI was associated with increased spacer utilization (20.9% of patients in Q1 vs. 28.2% of patients in Q5; p<0.001). Conclusion: While rectal spacer utilization is increasing overall, variations persist across geographic regions and demographic groups. These findings highlight the complex interplay of socioeconomic, geographic, and racial factors in treatment access and decision-making for prostate cancer patients. Additional research and targeted interventions are necessary to understand and address disparities to improve outcomes.
