Barriers to Access Palliative Radiotherapy in Prostate Cancer - A Population-Based Study.

Purpose/Objective(s) With improvements in systemic therapy, patients with metastatic malignancies are living longer; however, access to adequate palliative radiotherapy remains an issue. In this study, we aim to describe factors important in access to palliative radiotherapy in patients who received novel Androgen receptor-axis-targeted therapies (ARAT) and died of prostate cancer. The main objective of this investigation was to identify and describe the factors important to receipt of palliative radiation treatment and the barriers to access in patients with prostate cancer in Ontario, Canada. Materials/Methods Population-based administrative databases from Ontario, Canada were used to identify patients 65 years or older with prostate cancer who were eligible for Ontario Drug Benefit 2002-2018 (n = 138,976), received continuous androgen deprivation therapy (ADT, n = 37,578), and died of prostate cancer-specific death between 2013 and 2017 (n = 3,575). Baseline and treatment characteristics were analyzed for association with receipt of radiotherapy in a 2-year observation period prior to death. Results 48.4% of patients who were included in the study received palliative radiotherapy to bone in the two years preceding death despite 51.3 % presenting with metastasis. Potential barriers to access to radiation treatment in patients with lethal castration-resistant prostate cancer in Ontario include cancer center consultation, type of oncologist involved, patient distance to cancer center, or socioeconomic factors, such as income quartile and rurality index. Conclusion The role of palliative radiotherapy has become increasingly recognized constituting nearly half the courses of radiation therapy delivered in Ontario. However, unimpeded access to radiation therapy continues to be a challenge, as evident from a high proportion of patients dying of prostate cancer in Ontario who never received palliative radiotherapy. We aimed to identify socioeconomic factors that might have accounted for the gap between the actual and optimal rates of receipt of radiotherapy to be able to improve the quality of life of many incurable patients.