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Variation in Treatment Planning of Radiation Therapy Procedures in the United States

February 19, 2021

A recent study suggests that provider characteristics, like gender, geographic region in which they practice, and years since graduation, may influence the selection of radiation planning techniques for Medicare patients (JCO Oncol Pract. 2021; OP2000441. doi:10.1200/OP.20.00441).

“Variation in the use of radiation oncology procedures and technologies is poorly characterized,” wrote Luca F. Valle, MD, Department of Radiation Oncology, University of California, and colleagues.

This analysis aimed to describe associations between treatment planning codes used to bill for radiotherapy procedures, and the characteristics of the physicians submitting them.

This study used data collected from physician National Provider Identifier for the year 2016. A total of 3029 physicians were identified and stratified by practice setting: freestanding non-facility-based and facility-based (FB).

Provider characteristics like gender, practice rurality, and years since graduation were observed. Multivariable logistic regression was used to determine the characteristics that predicted for the use of 3D-conformal RT (3DCRT) planning, intensity-modulated RT (IMPRT) planning, and brachytherapy planning in the Medicare population.

Male gender predicted decreased likelihood of 3DCRT planning (OR, 0.70, 95% CI, 0.62 to 0.80, P <.001) and increased likelihood of IMRT planning (OR, 1.35, 95% CI, 1.19 to 1.54, P <.001), in both settings. Brachytherapy planning was also more likely among male providers (OR, 1.75, 95% CI, 1.10 to 2.76, P = .02).

In addition, the analysis found that providers in metropolitan regions were more likely to opt for brachytherapy planning, compared to those in rural areas (OR, 3.01, 95% CI, 1.23 to 7.39, P = .02).

This study finds that IMRT planning is more associated with male providers, while 3DCRT planning is more associated with female providers. “Future research is warranted to better understand the role that provider gender and rurality play in the selection of radiation planning techniques for Medicare patients,” concluded Dr Valle and colleagues.Marta Rybczynski

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