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Factors Associated With Rectal Spacer Use in Prostate Cancer Patients Receiving Radiation Therapy.

Ryan A Hankins1, Kathryn C Morris2, Alysha M McGovern2

  • 1MedStar Georgetown University Hospital, Washington, DC, USA.

Cancer Medicine
|April 28, 2026
PubMed
Summary

Rectal spacer use in prostate cancer radiation therapy increased significantly from 2017 to 2021. Utilization varied by region, race, income, and treatment type, indicating disparities in access to this protective measure.

Keywords:
SBRTdisparitiesprostate cancerproton therapyradiation therapyrectal spacerrectal toxicityutilization

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Health Services Research

Background:

  • Prostate cancer is a leading cause of cancer death in US men.
  • Factors influencing rectal spacer use in radiation therapy are not well understood.
  • Rectal spacers can reduce radiation-induced rectal toxicity.

Purpose of the Study:

  • To evaluate rectal spacer utilization trends among Medicare beneficiaries with prostate cancer.
  • To analyze variations in rectal spacer use based on demographic, socioeconomic, regional, and treatment factors.
  • To identify disparities in access to rectal spacers during prostate cancer radiation therapy.

Main Methods:

  • Analysis of Medicare 5% Standard Analytical Files (2017-2021).
  • Inclusion of men aged 65+ with prostate cancer treated with IMRT, SBRT, brachytherapy, or proton therapy.
  • Stratification by rectal spacer placement within 60 days pre-radiation therapy.

Main Results:

  • Overall rectal spacer utilization rose from 6.8% (2017) to 42.4% (2021).
  • Utilization varied geographically (West: 31.7%, Northeast: 23.6%), by race (White vs. Black disparities), and income (increasing with quintile).
  • Proton therapy (59.0%) and SBRT (46.0%) showed higher utilization than brachytherapy (23.7%) and IMRT (20.6%).

Conclusions:

  • Significant increase in rectal spacer use observed from 2017-2021, particularly with proton therapy and SBRT.
  • Geographic, racial, and income-based variations highlight complex factors affecting treatment access.
  • Further research is needed to address disparities and optimize rectal spacer use for all eligible patients.