Young Adult Populations Face Yet Another Barrier to Care With Insurers: Limited Access to Proton Therapy.

Tytuł:: Young Adult Populations Face Yet Another Barrier to Care With Insurers: Limited Access to Proton Therapy.
Autorzy:: Bishop AJ; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: .
Livingston JA; Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Ning MS; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Valdez ID; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Wages CA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
McAleer MF; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Paulino AC; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Grosshans DR; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Woodhouse KD; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Tao R; Department of Radiation Oncology at the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
Roth ME; Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Gunn GB; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
McGovern SL; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Źródło:: International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2021 Aug 01; Vol. 110 (5), pp. 1496-1504. Date of Electronic Publication: 2021 Mar 04.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural
Język:: English
Imprint Name(s):: Publication: New York, NY : Elsevier, Inc
Original Publication: Elmsford, N. Y., Pergamon Press.
MeSH Terms:: Age Factors*
Insurance, Health, Reimbursement*/statistics & numerical data
Health Services Accessibility/*statistics & numerical data
Insurance Coverage/*statistics & numerical data
Insurance, Health/*statistics & numerical data
Proton Therapy/*statistics & numerical data
Adolescent ; Adult ; Brain Neoplasms/radiotherapy ; Child ; Child, Preschool ; Craniospinal Irradiation/statistics & numerical data ; Cross-Sectional Studies ; Head and Neck Neoplasms/radiotherapy ; Humans ; Infant ; Infant, Newborn ; Insurance Carriers ; Neoplasms, Radiation-Induced/prevention & control ; Proton Therapy/adverse effects ; Spinal Neoplasms/radiotherapy ; Time Factors ; Young Adult
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Grant Information:: P30 CA016672 United States CA NCI NIH HHS
Entry Date(s):: Date Created: 20210307 Date Completed: 20210923 Latest Revision: 20220802
Update Code:: 20240104
PubMed Central ID:: PMC8286292
DOI:: 10.1016/j.ijrobp.2021.02.049
PMID:: 33677051
: Czasopismo naukowe

Purpose: Young patients, including pediatric, adolescent, and young adult (YA) patients, are most likely to benefit from the reduced integral dose of proton beam radiation therapy (PBT) resulting in fewer late toxicities and secondary malignancies. This study sought to examine insurance approval and appeal outcomes for PBT among YA patients compared with pediatric patients at a large-volume proton therapy center.
Methods and Materials: We performed a cross-sectional cohort study of 284 consecutive patients aged 0 to 39 years for whom PBT was recommended in 2018 through 2019. Pediatric patients were defined as aged 0 to 18 years and YA patients 19 to 39 years. Rates of approval, denials, and decision timelines were calculated. Tumor type and location were also evaluated as factors that may influence insurance decisions.
Results: A total of 207 patients (73%) were approved for PBT at initial request. YA patients (n = 68/143, 48%) were significantly less likely to receive initial approval compared with pediatric patients (n = 139/141; 99%) (P < .001). Even after 47% (n = 35 of 75) of the PBT denials for YA patients were overturned, YAs had a significantly lower final PBT approval (72% vs pediatric 99%; P < .001). The median wait time was also significantly longer for YA patients (median, 8 days; interquartile range [IQR] 3-17 vs median, 2 days; IQR, 0-6; P < .001). In those patients requiring an appeal, the median wait time was 16 days (IQR, 9-25).
Conclusion: Given the decades of survivorship of YA patients, PBT is an important tool to reduce late toxicities and secondary malignancies. Compared with pediatric patients, YA patients are significantly less likely to receive insurance approval for PBT. Insurance denials and subsequent appeal requests result in significant delays for YA patients. Insurers need to re-examine their policies to include expedited decisions and appeals and removal of arbitrary age cutoffs so that YA patients can gain easier access to PBT. Furthermore, consensus guidelines encouraging greater PBT access for YA may be warranted from both medical societies and/or AYA experts.
(Copyright © 2021 Elsevier Inc. All rights reserved.)

Comment in: Int J Radiat Oncol Biol Phys. 2021 Aug 1;110(5):1505-1507. (PMID: 34273324)
Comment in: Int J Radiat Oncol Biol Phys. 2021 Aug 1;110(5):1538-1539. (PMID: 34273325)

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