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Barriers to Receiving Proton-Craniospinal Irradiation for Pediatric Medulloblastoma Patients at a Rural Tertiary Care
Melisa Pasli1, Megan Goins2, Michael C Larkins2,3
1Medicine, East Carolina University (ECU) Brody School of Medicine (BSOM), Greenville, USA.
Insights
This study examined barriers to proton craniospinal irradiation (CSI) for rural pediatric medulloblastoma patients. No significant associations were found between common barriers and proton-CSI access, highlighting a need for improved care access.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Cancer Care Access
Background:
- Medulloblastoma is a primary childhood cancer.
- Craniospinal irradiation (CSI) is a common treatment.
- Barriers to proton-CSI for rural pediatric patients are explored.
Purpose of the Study:
- To identify barriers to proton-CSI for rural pediatric medulloblastoma patients.
- To analyze geographic, social, and financial factors influencing treatment access.
- To inform strategies for overcoming access challenges.
Main Methods:
- Retrospective chart review of pediatric medulloblastoma patients (<25 years) at a rural tertiary center.
- Analysis of barriers including distance, time, income, and race.
- Descriptive and statistical analyses (Kruskal-Wallis H, chi-square) were performed.
Main Results:
- No significant associations found between identified barriers and proton-CSI discussion or pursuit.
- Median follow-up was five years; only 3 patients received proton-CSI, all Caucasian.
- Non-Caucasian patients had shorter median travel times (p=0.068).
Conclusions:
- This is the first study on proton-CSI access barriers for pediatric medulloblastoma patients lacking in-state facilities.
- Geographic, social, and financial barriers are identified, necessitating solutions.
- Advocacy is crucial to expand state and national treatment access for this population.
Introduction:
Medulloblastoma is predominantly a childhood cancer, with craniospinal irradiation (CSI) being a common treatment modality. Here, we discuss barriers to proton-CSI for rural pediatric medulloblastoma patients.
Methods:
Pediatric patients <25 years old with a diagnosis of medulloblastoma were identified from a tumor registry at a rural tertiary academic center. A chart review was conducted to identify specific barriers to proton CSI, namely distance and time to the nearest proton therapy facility, median household income, and race. Descriptive and statistical analyses using the Kruskal-Wallis H test and chi-square were conducted in IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States) to describe this cohort and their barriers.
Results:
Of the 18 pediatric medulloblastoma patients identified, no significant associations were found between barriers of interest and discussion or pursuit of proton-CSI. Median follow-up time was five years. All three patients who received proton-CSI were Caucasian patients. Non-Caucasian patients had shorter median travel times, with the association approaching significance (p = 0.068). No significant associations were found between county, parent employment and marital status, tumor classification, risk stratification, and the reception of proton-CSI or its discussion.
Conclusion:
To the best of our knowledge, this is the first study on barriers to accessing proton-CSI for pediatric medulloblastoma patients without in-state proton-CSI centers. Our study provides insight into geographic, social, and financial barriers, allowing clinical teams to identify solutions to overcome these barriers. Advocacy for access to care on behalf of this vulnerable patient population will expand treatment access on a state and national level.
