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There are widely-recognized disparities in access to all types of healthcare across race and socioeconomic status. This propensity-matched NCDB analysis aimed to analyze this trend in proton therapy, and broadly included patients receiving cancer treatment at centers where at least 5 patients received proton therapy between 2004-2018. As expected, patients identified as Black were significantly less likely to receive proton therapy (0.3%) than White counterparts (0.5%). Of note, socioeconomic and insurance coverage variables were not controlled for, given their inextricable links to race. Disparities were more pronounced among those with “group 1” cancers (e.g., ocular, H&N, CNS tumors) where there are frequent scenarios (e.g., reirradiation, sufficient target coverage precludes meeting crucial constraints for a nearby structure, avoiding low-dose spill in very young patients) that support the use of proton therapy: 0.4% versus 0.8%, respectively. While there are quite the inferential leaps made here—we have no idea if the patients receiving proton therapy achieved dosimetric advantages, much less clinical ones—it does reveal predictable lines drawn by racial and socioeconomic demographics. | Nogueira, JAMA Netw Open 2022


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