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Radiation Therapy Infrastructure, Social Vulnerability, and Insurance Architecture Predict Timely Postoperative
Peter F Orio1,2, Peter Nakaji3,4, Tim Frandsen5
1Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Advances in Radiation Oncology
|July 1, 2026
Summary
Timely radiation therapy (RT) initiation after brain tumor surgery is crucial but often delayed. Factors like RT center density, proximity, insurance, and social vulnerability significantly impact timely treatment, with capacity improvements only partially overcoming barriers.
Area of Science:
- Oncology
- Health Services Research
- Public Health
Background:
- Timely radiation therapy (RT) initiation post-craniotomy for malignant brain tumors is linked to improved patient outcomes.
- Despite established guidelines, the prompt commencement of postoperative RT remains a challenge in clinical practice.
Purpose of the Study:
- To investigate the independent and interactive effects of structural, social, and payer-related factors on the initiation of RT following craniotomy.
- To identify key determinants influencing the timeliness of postoperative RT delivery for brain tumor patients.
Main Methods:
- Retrospective cohort study utilizing a comprehensive dataset including all-payer claims, hospital geospatial data, and community vulnerability indicators.
- Analysis of RT initiation at 42-, 60-, and 90-day postoperative intervals, examining predictors such as RT center density, hospital proximity, payer type, and Social Vulnerability Index (SVI).
Main Results:
- Only 29.2% of 18,885 patients initiated RT within 42 days post-craniotomy.
- Higher RT center density and hospital proximity were associated with earlier RT initiation.
- Medicaid coverage and higher community social vulnerability (e.g., elderly population, transportation barriers) were linked to delayed RT initiation, although increased regional RT capacity showed a mitigating effect.
Conclusions:
- Structural, socioeconomic, and insurance factors significantly influence the timely initiation of postoperative RT.
- While increasing regional RT capacity can improve initiation rates, it does not fully overcome social and payer-related disparities in treatment access.
