{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:54:19Z","timestamp":1781585659416,"version":"3.54.5"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008497","name":"Boston Scientific Corporation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Objective<\/jats:title>\n                    <jats:p>Prostate cancer is a leading cause of cancer\u2010related death among men in the United States. However, the influence of demographic, socioeconomic, regional, and treatment\u2010related factors on rectal spacer use among men treated with radiation therapy remains largely unexplored in the literature. This study evaluated rectal spacer utilization among Medicare beneficiaries with prostate cancer by radiation therapy modality, region, race, income, and year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Medicare 5% Standard Analytical Files were used to identify men aged 65+ with prostate cancer who underwent treatment with intensity\u2010modulated radiotherapy (IMRT), stereotactic body radiation (SBRT), brachytherapy, or proton therapy from 1\/1\/2017\u201312\/31\/2021. Patients were stratified by rectal spacer placement within 60\u2009days pre\u2010radiation therapy initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 66,680 patients were identified (mean age 72.8\u2009years, mean Charlson Comorbidity Index score 3.26, 80.7% White). Among this cohort, 17,940 patients (26.9%) received a rectal spacer. Spacer utilization increased significantly over time, from 6.8% in 2017 to 42.4% in 2021 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Geographic variation was observed, with the highest utilization in the West (31.7%) and the lowest in the Northeast (23.6%). A greater proportion of White patients received rectal spacers than Black patients in all regions except the Northeast (West: 32.6% vs. 22.2%; South: 30.8% vs. 20.5%; Midwest: 24.4% vs. 15.5%; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), where the opposite was observed (31.8% vs. 22.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Rectal spacer utilization increased with income, ranging from 20.9% in the lowest income quintile to 28.2% in the highest (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). By treatment modality, utilization was highest among patients receiving proton therapy (59.0%), followed by SBRT (46.0%), brachytherapy (23.7%), and IMRT (20.6%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rectal spacer utilization increased significantly from 2017 to 2021, with the greatest relative increases among proton therapy patients and SBRT patients. Significant variations based on geographic region, race, and income highlight the complex interplay of these factors on treatment access and decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71765","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T08:10:31Z","timestamp":1777363831000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Rectal Spacer Use in Prostate Cancer Patients Receiving Radiation Therapy"],"prefix":"10.1002","volume":"15","author":[{"given":"Ryan A.","family":"Hankins","sequence":"first","affiliation":[{"name":"MedStar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn C.","family":"Morris","sequence":"additional","affiliation":[{"name":"Boston Scientific  Marlborough Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6486-1788","authenticated-orcid":false,"given":"Alysha M.","family":"McGovern","sequence":"additional","affiliation":[{"name":"Boston Scientific  Marlborough Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Zack","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean P.","family":"Collins","sequence":"additional","affiliation":[{"name":"USF Health Morsani College of Medicine  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3119-3226","authenticated-orcid":false,"given":"James B.","family":"Yu","sequence":"additional","affiliation":[{"name":"Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"},{"name":"Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2214122"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606221"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.11.044"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2008.02.073"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.06.054"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1470\u20102045(07)70143\u20102"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.21037\/qims.2018.06.06"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717x\u20105\u201027"},{"issue":"4","key":"e_1_2_11_10_1","first-page":"6373","article-title":"Late Toxicity Rates Following Definitive Radiotherapy for Prostate Cancer","volume":"19","author":"Ohri N.","year":"2012","journal-title":"Canadian Journal of Urology"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14071670"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391\u2010022\u201000520\u2010x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2024.07.244"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sipas.2023.100216"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2023.03.015"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/pcan.2009.56"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.04.030"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2016.12.024"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.8221"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/tomography8060221"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urpr.2014.03.004"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpt.2024.100111"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2017.75.5371"},{"key":"e_1_2_11_24_1","doi-asserted-by":"crossref","unstructured":"N. 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