Compared with conventional external-beam radiation therapy (cEBRT) for patients with breast cancer (BC) and prostate cancer (PC), shorter radiation regimens may be associated with lower treatment noncompletion rates. We assess disparities in receipt of shorter radiation regimens and treatment noncompletion for BC and PC.

The 2004-2017 National Cancer Database was queried for adjuvant cEBRT or hypofractionated EBRT (hEBRT) for nonmetastatic BC; and definitive cEBRT, moderate hypofractionation (mEBRT), or stereotactic body radiotherapy (SBRT) for localized PC. Multivariable logistic regression identified factors associated with treatment noncompletion and receipt of shorter regimens.

We identified 170,386 men with PC (median age [interquartile range], 70 [64-75] years; Black, 17.5%; White, 82.5%) and 306,846 women with BC (61 [52-69] years; Black, 12.3%; White, 87.7%). Among patients who received cEBRT for PC, Black men had higher treatment noncompletion rates compared with White (14.1% v 13.0%; odds ratio [95% CI] 1.07 [1.03 to 1.12]; P < .001). In contrast, treatment noncompletion was not disparate with SBRT (Black 1.6% v White 1.3%; 1.20 [0.72 to 2.00], P = .49) or mEBRT (Black 9.0% v White 7.1%; 1.05 [0.72 to 1.54], P = .79). From 2004 to 2017, SBRT (0.07% to 11.8%; 1.32 [1.31 to 1.33]) and mEBRT (0.35% to 9.1%; 1.27 [1.25 to 1.28]) increased (both P < .001); however, Black men were consistently less likely to receive SBRT (7.4% v White, 8.3%; 0.84 [0.79 to 0.89], P < .001). Among women with BC, there were no racial differences in treatment noncompletion; however, hEBRT was associated with lower treatment noncompletion rates (1.0% v cEBRT 2.3%; 0.39 [0.35 to 0.44], P < .001). Although hEBRT for BC increased (0.8% to 35.6%) between 2004 and 2017, Black women were less likely to receive hEBRT (10.4% v 15.3%; 0.78 [0.75 to 0.81], P < .001).

Black patients were consistently less likely to receive hypofractionated radiation for PC or BC, despite evidence suggesting that shorter regimens may lower rates of treatment noncompletion with similar oncologic outcomes.

E.C.D., F.L.C., S.N.M., E.F.G., and P.M.G.S. are funded in part through the NIH/NCI Support Grant P30 CA008748. E.F.G. reports additional funding from the National Cancer Care Network/Pfizer EMBRACE. B.A.M. receives funding from the Prostate Cancer Foundation (PCF) and the American Society for Radiation Oncology (ASTRO). N.V. receives funding from the PCF and NIH/NCI outside the submitted work.

Conception and design: Edward Christopher Dee, Neil K. Taunk, Fumiko L. Chino, Brandon A. Mahal, Neha Vapiwala, Patricia Mae G. Santos

Administrative support: Patricia Mae G. Santos

Collection and assembly of data: Edward Christopher Dee, Patricia Mae G. Santos

Data analysis and interpretation: Edward Christopher Dee, Neil K. Taunk, Fumiko L. Chino, Vinayak Muralidhar, Sean N. McBride, Erin F. Gillespie, Kosj Yamoah, Paul L. Nguyen, Brandon A. Mahal, Karen M. Winkfield, Neha Vapiwala, Patricia Mae G. Santos

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Shorter Radiation Regimens and Treatment Noncompletion Among Patients With Breast and Prostate Cancer in the United States: an Analysis of Racial Disparities in Access and Quality

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

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Edward Christopher Dee

Other Relationship: NIH/NCI

Neil K. Taunk

Honoraria: Sensus

Consulting or Advisory Role: Boston Scientific, Indi Molecular

Fumiko L. Chino

This author is the Social Media Editor of JCO Oncology Practice Editorial Board. Journal policy recused the author from having any role in the peer review of this manuscript.

Curtiland Deville Jr

Consulting or Advisory Role: Blue Earth Diagnostics, AstraZeneca

Shearwood McClelland

Consulting or Advisory Role: Gilmartin Capital

Vinayak Muralidhar

Employment: Northwest Permanente

Sean N. McBride

Consulting or Advisory Role: Janssen, AstraZeneca

Research Funding: Genentech, AstraZeneca

Erin F. Gillespie

Other Relationship: eContour

Kosj Yamoah

Consulting or Advisory Role: Janssen Research & Development LLC, MyCareGorithm LLC

Paul L. Nguyen

Stock and Other Ownership Interests: Volatilyx

Consulting or Advisory Role: Bayer, Blue Earth Diagnostics, Boston Scientific, Janssen Oncology, Myovant Sciences

Research Funding: Astellas Pharma, Janssen, Bayer

Patents, Royalties, Other Intellectual Property: Wife has a patent on volatile diagnostics of infections

Brandon A. Mahal

Honoraria: Cancer Study Group

Speakers' Bureau: Myovant Sciences

Other Relationship: Prostate Cancer Foundation, Department of Defense-Prostate Cancer Research Program, American Society for Radiation Oncology

Karen M. Winkfield

Honoraria: Takeda

Consulting or Advisory Role: Merck, Pfizer, Bristol Myers Squibb, GRAIL, AstraZeneca

No other potential conflicts of interest were reported.