Trends and Patterns of Proton Therapy Utilization Among Patients With Head and Neck Cancer: Analysis from the National Cancer Database (2005-2014)

Abstract

To analyze national trends and patterns of proton therapy use among patients with head and neck cancer. Using the National Cancer Database, we identified patients diagnosed with any head and neck primary malignancy of all stages between 2005 and 2014. Patients treated with radiation therapy and proton therapy directed specifically to the primary site were selected. Distribution of patient/clinical factors, socioeconomic status, demographic factors, and treatment facility type were evaluated. Univariable and multivariable logistic regression was used to correlate factors associated with proton therapy use compared to other modalities of radiation therapy. There were 245,859 who received any radiation therapy as part of their initial treatment course and 468 (0.2%) who received proton therapy. The use of protons underwent a small increase in utilization from 0.1% in 2005 to 0.4% by 2014 (OR 3.041, P<.001). The most common primary sites treated with proton therapy were the nasal cavity/nasopharynx (n=174, 37.2%) and the oral cavity (n=107, 22.9%). On multivariate logistic regression, treatment at an academic facility (OR 2.345, P<.001), income >$63,000 (OR 1.606, P<.001) and most recent years of diagnosis (2013-2014, OR 3.050, P<.001) were associated with increased likelihood of receiving proton therapy. In addition, patients who received proton therapy were more likely to travel a longer distance for treatment (OR 1.918, P<.001) compared to those receiving other modalities of radiation. Higher Charlson/Deyo comorbidity score (OR 0.729, P=.033), non-white race (OR 0.605, P=.004), geographic regions in the south (OR 0.320, P<.001) or mid-west (OR 0.488, P<.001), and urban locations (OR 0.447, P=.001) compared to metropolitan areas were associated with decreased likelihood of receiving proton therapy. There were no differences in utilization with age or with history of second primary cancers. Protons have undergone an incremental increase in utilization in the United States, but remains an uncommon modality for treatment of head and neck cancer. As the indications and benefits of proton therapy in head and neck cancer continue to emerge, decreasing the cost of its use and increasing its availability is necessary to reduce disparities in the provision of proton therapy.