Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2022-06-23 eCollection Date: 2022-01-01 DOI:10.14338/IJPT-22-00001.1
Steven H Lin, Kaiping Liao, Xiudong Lei, Vivek Verma, Sherif Shaaban, Percy Lee, Aileen B Chen, Albert C Koong, Wayne L Hoftstetter, Steven J Frank, Zhongxing Liao, Ya-Chen Tina Shih, Sharon H Giordano, Grace L Smith
{"title":"Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.","authors":"Steven H Lin,&nbsp;Kaiping Liao,&nbsp;Xiudong Lei,&nbsp;Vivek Verma,&nbsp;Sherif Shaaban,&nbsp;Percy Lee,&nbsp;Aileen B Chen,&nbsp;Albert C Koong,&nbsp;Wayne L Hoftstetter,&nbsp;Steven J Frank,&nbsp;Zhongxing Liao,&nbsp;Ya-Chen Tina Shih,&nbsp;Sharon H Giordano,&nbsp;Grace L Smith","doi":"10.14338/IJPT-22-00001.1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.</p><p><strong>Materials and methods: </strong>We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.</p><p><strong>Results: </strong>Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; <i>P</i> < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; <i>P</i> = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; <i>P</i> = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; <i>P</i> < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; <i>P</i> = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; <i>P</i> = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238132/pdf/","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Particle Therapy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14338/IJPT-22-00001.1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 2

Abstract

Purpose: In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.

Materials and methods: We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.

Results: Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; P < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; P = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; P = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; P < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; P = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; P = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; P = .02).

Conclusion: Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.

Abstract Image

Abstract Image

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
食管癌质子与光子放射治疗的保健资源利用。
目的:在接受放化疗的食管癌(EC)患者中,随机试验数据表明,与调强放疗(IMRT)相比,质子束治疗(PBT)可减少毒性和术后并发症(POCs)。然而,放射治疗方式是否影响术后医疗资源的利用仍然未知。材料和方法:我们研究了287例接受放化疗(处方50.4 Gy/GyE)后食管切除术的EC患者,包括一个现实世界的观察队列,从2007年到2013年,连续237例患者接受PBT (n = 81)和IMRT (n = 156)治疗;以及一项独立的当代比较队列,来自2012年至2019年接受PBT (n = 21)和IMRT (n = 29)治疗的随机试验的50名患者。从病历中提取术后并发症。保健费用来自机构索赔,并根据通货膨胀进行调整(2021美元)。电荷差异(Δ = $PBT - $IMRT)采用调整后的广义线性模型与伽马分布进行比较。结果:基线PBT与IMRT特征无显著差异。在观察队列中,在新辅助放化疗阶段,PBT的医疗费用高于IMRT (Δ = +$71,959;95%置信区间[CI]为62,274- 82,138美元;P < 0.001)。手术费用没有差别(Δ = - 2234美元;95%置信区间为- 6003美元至1695美元;P = .26)。然而,在食管切除术后住院期间,PBT的医疗费用低于IMRT (Δ = -$25,115;95% CI, - 37,625至- 9776美元;P = .003)。在比较队列中,结果是类似的:放化疗期间PBT的费用高于IMRT (Δ = + 61,818美元;95% ci, 49,435- 75,069美元;P < .001),手术无差异(Δ = -$4784;95% CI, - 6439至3487美元;P = .25),而术后PBT的比例更低(Δ = - 27,048美元;95% CI, - 41974至- 5300美元;P = .02)。在当代比较中,PBT的术后费用较低,特别是在任何POCs患者中(Δ = - 176,448美元;95% CI, - 209,782至- 78,813美元;P = .02)。结论:EC患者术前PBT放化疗资源利用率的提高在术后被部分抵消,并因POC风险的降低而得到缓和。结果扩展了PBT降低毒性的现有临床证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
期刊最新文献
Vaginal Mucosal Melanoma Cell Activation in Response to Photon or Carbon Ion Irradiation. Navigating a New Frontier: Evaluating Leadless Pacemakers in Proton Therapy. Cardiac Conduction System as an OAR in Radiation Therapy: Doses to SA/AV Nodes and Their Reduction. Value of Carbon-Ion Radiation Therapy for Breast Cancer. Reducing Radiation Dermatitis for PBS Proton Therapy Breast Cancer Patients Using SpotDelete.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1