Radiation Therapy Adherence Among Patients Experiencing Homelessness

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Radiation therapy is a critical cancer treatment but is resource-intensive.
• Patients experiencing homelessness (PEH) encounter significant barriers to accessing timely radiation therapy.
• Limited data exists on cancer treatment adherence for PEH, hindering evidence-based clinical recommendations.

Purpose of the Study:

• To evaluate adherence to radiation therapy treatment regimens among patients experiencing homelessness (PEH) with cancer.
• To compare radiation therapy completion rates and delays between PEH and a non-homeless comparison group.

Main Methods:

• Retrospective chart review of patients with radiation oncology visits from Vanderbilt University Medical Center's Homeless Health Services program.
• Identification of 32 PEH prescribed radiation therapy, with data on course completion, delays, and missed appointments.
• Comparison with a non-homeless (non-PEH) patient cohort receiving similar radiation treatments.

Main Results:

• Of 32 PEH prescribed radiation, 62.9% completed courses as prescribed, 22.2% with delays, and 14.8% incompletely.
• While PEH had higher rates of delayed/undelivered fractions, overall delayed or incomplete course proportions were similar to non-PEH, especially for shorter regimens (≤10 fractions).
• Variable reasons contributed to missed appointments among PEH.

Conclusions:

• This study is the first to report on radiation therapy adherence in PEH.
• PEH demonstrate similar completion rates to non-PEH, but with increased treatment interruptions.
• Hypofractionated regimens may benefit PEH for courses >10 fractions, pending efficacy data; understanding missed appointment reasons is crucial for improving care.