Demographic differences in receiving external beam vs brachytherapy radiation in primary ocular cancers.

Abstract

163 Background: Primary ocular cancers are rare but may be lethal if not treated appropriately. Previously, enucleation was commonly recommended as treatment but has been associated with increased psychosocial disturbances. More recently, brachytherapy and external beam radiation therapy (EBRT) have been used instead due to similar survival outcomes and the opportunity to salvage the eye. Brachytherapy allows for more precise, high dose radiation to be localized to the tumor and minimizes exposure to nearby tissues and, thus, secondary complications. Due to this possible variance of outcomes between radiation therapies, it would be beneficial to examine the demographic differences of those who undergo each modality in the treatment of primary eye cancers. Methods: 2,783 patients diagnosed with a primary ocular cancer that underwent phase I treatment via either EBRT or brachytherapy were isolated using the National Cancer Database from the years 2016 – 2020. Multivariate binary logistic regression and descriptive statistics were used to compare the demographics associated with those who underwent EBRT vs brachytherapy. A p-value of < 0.05 was used to determine significance. Results: Private-insured and Medicare-insured patients were 224.9% and 155.2%, respectively, more likely than uninsured patients to receive brachytherapy. Patients in the third quartile for median household income were 28.4% less likely than those in the upper quartile to receive brachytherapy. Males were 40.2% less likely than females to receive brachytherapy. Compared to White patients, Black and Asian patients were less likely (81.6% and 83.8%) to undergo brachytherapy. Patients identifying as Hispanic/Spanish were 58.4% less likely than non-Hispanic/non-Spanish patients. There were no significant differences found when comparing Charlson-Deyo scores. Conclusions: Patients who are uninsured, in the third quartile for median household income, male, Black, Asian, or Hispanic/Spanish were less likely to undergo brachytherapy compared to EBRT. These findings illustrate that there are significant differences in the groups who undergo recommended radiation modalities for primary ocular cancers. Awareness of these disparities can help us understand the importance of ameliorating healthcare inequalities in the treatment of eye cancers.