All ETDs from UAB

Advisory Committee Chair

Meredith L Kilgore

Advisory Committee Members

Julie Locher

Richard Popple

Bisakha Sen

Jeffery Szychowski

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


PURPOSE: Intensity-modulated radiotherapy (IMRT) is a development of conventional radiotherapy in the treatment for most Head and Neck Cancers (HNC). There is no sufficient evidence to suggest that some physicians are associated with better outcomes in HNC patients. Also, there is limited data that showed that African Americans have poor outcomes compared to other races among HNC patients. We conducted a cross-sectional analysis to evaluate the effect of radiation oncologist characteristics on outcomes in HNC patients treated with IMRT, and factors associated with racial disparities in the treatment outcomes. METHODS: The study used Surveillance Epidemiology and End Results (SEER)-Medicare linked database for patients’ characteristics. Physicians records were obtained from American Medical Association. Statistical comparisons were conducted using Chi-square and paired t-test. Logistic regression models and Linear probability models with fixed effect for physicians were analyzed to look for association between physicians’ characteristics and patients’ outcomes. RESULTS: The study found that physicians who were trained on or after year 2000 were associated with higher odds (OR=1.10, p=0.021) of an adverse effect of IMRT or death among the patients. Physicians working in academic settings have a protective effect (OR=0.72, p=0.010) and were significantly associated with the outcome. The study indicates that the relationship between provider volume and patient outcomes can vary widely by how provider volume is operationalized. African Americans were more likely to have an adverse effect of IMRT (OR=1.14, p=0.037). The cancer stage mediate the outcomes among African-Americans. CONCLUSION: Physicians who completed their radiation oncology training before the year 2000 tended to have better outcomes. Similarly, physicians who work in academic settings are also more likely to be associated with better outcomes. There is a nonlinear association between provider volume and patient outcomes. Patient outcomes improve with an increase in the number of patients treated and procedures performed by the physician, but only up to a certain point. The advance staging of HNC at the time of diagnosis is a major factor that predisposes to poor survival and more adverse effect of radiation treatment among African-American population.

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