MSPP03 Presentation Time: 4:20 PM

Purpose

According to the American Society of Radiation Oncology (ASTRO), there are approximately 5,000 practicing radiation oncologists (RO) in the United States (US). It is unknown, however, how many of these RO practice brachytherapy. We used claims from Center for Medicare and Medicaid services (CMS) to estimate the number of RO who provide brachytherapy and examine trends in the number of patients that receive brachytherapy.

Materials and Methods

Using Medicare Provider Utilization and Payment Data (the Physician and Other Supplier Public Use File (POSPUF) publically available data set), we identified unique procedural codes related to brachytherapy practice in prostate, gynecologic (GYN), breast, and ocular cancers from 2013 to 2019. For each disease site, the total of rendering providers, beneficiaries, and services were identified. The number of patients who received brachytherapy and the number of procedures per 100,000 Medicare enrollees were also calculated. Yearly trends in services and number of providers were then developed. Trends were tested using the Kendall Tau rank correlation using R version 3.6.3.

Results

For prostate brachytherapy, the total number of patients receiving brachytherapy (6145 in 2013 to 5695 in 2019) and procedures performed (8609 to 7862) remained steady over the study period (p=0.76), while the number of providers dropped significantly by 32% (1981 to 1361, p=0.003). The number of providers providing brachytherapy remained steady for intrauterine implants (663 to 625, p=0.37), while the number of patients (4.3 to 3.2 per 100,000 enrollee, p=0.02) and performed procedures decreased (13.4 to 10.4 per 100,000 enrollee, p=0.02) from 2013 to 2019. There was a non-significant trend in decline of total patients (12%) and services (8.6%) over time (p=0.07). For intravaginal implants, total services increased by 45% (p=0.007) and patients increased by 36% (p=0.007). The number of patients and procedures per 100,000 Medicare enrollee (12.7 to 14.7, p=0.035 and 40.8 to 50.1, p=0.007, respectively) as well as the number of providers performing intravaginal implants increased by 31% (1070 to 1403, p=0.007) from 2013-2019. For breast, total providers decreased by 56.4%, as well as patients (-51.4%) and procedures (-52%, p=0.003, for all metrics). For ocular implants, the total number of patients and services remained steady (p=0.37 and p=0.37), while those performing decreased by 13% (p=0.048).

Discussion

There is an overall decline of providers performing brachytherapy for prostate and ocular cancers, although the number of procedures and patients remain the same. There is a decline in the number of RO providing and patients receiving brachytherapy for breast cancer. While the number of providers performing intrauterine implants remains steady, there is an increase in those performing vaginal implants, suggesting more RO are performing less complicated intracavitary vaginal implants. A decrease of patients requiring intrauterine implants may reflect either decreased indications (such as in cervical cancer with decreased incidence due to better screening and vaccination against Human Papillomavirus) or decreased utilization by providers in favor of other methods, such as with stereotactic body radiotherapy (SBRT). A potential limitation of this study includes the inability to identify individual providers who may be included in multiple disease categories and thus, overestimating the total number of providers. These data underlie the need for increased brachytherapy training to ensure that utilization rates for all forms of brachytherapy match the clinical indications.