# Barriers to Receiving Proton-Craniospinal Irradiation for Pediatric Medulloblastoma Patients at a Rural Tertiary Care Center

## TL;DR

This study explores challenges faced by rural pediatric medulloblastoma patients in accessing proton craniospinal irradiation treatment.

## Contribution

The paper is the first to examine barriers to proton-CSI for pediatric medulloblastoma patients in a rural setting without local proton therapy facilities.

## Key findings

- No significant associations were found between barriers and proton-CSI discussion or pursuit.
- Non-Caucasian patients had shorter median travel times, with a near-significant association.
- All three patients who received proton-CSI were Caucasian.

## Abstract

Introduction: Medulloblastoma is predominantly a childhood cancer, with craniospinal irradiation (CSI) being a common treatment modality. Here, we discuss barriers to proton-CSI for rural pediatric medulloblastoma patients.

Methods: Pediatric patients <25 years old with a diagnosis of medulloblastoma were identified from a tumor registry at a rural tertiary academic center. A chart review was conducted to identify specific barriers to proton CSI, namely distance and time to the nearest proton therapy facility, median household income, and race. Descriptive and statistical analyses using the Kruskal-Wallis H test and chi-square were conducted in IBM SPSS Statistics for Windows, Version 28 (Released 2021; IBM Corp., Armonk, New York, United States) to describe this cohort and their barriers.

Results: Of the 18 pediatric medulloblastoma patients identified, no significant associations were found between barriers of interest and discussion or pursuit of proton-CSI. Median follow-up time was five years. All three patients who received proton-CSI were Caucasian patients. Non-Caucasian patients had shorter median travel times, with the association approaching significance (p = 0.068). No significant associations were found between county, parent employment and marital status, tumor classification, risk stratification, and the reception of proton-CSI or its discussion.

Conclusion: To the best of our knowledge, this is the first study on barriers to accessing proton-CSI for pediatric medulloblastoma patients without in-state proton-CSI centers. Our study provides insight into geographic, social, and financial barriers, allowing clinical teams to identify solutions to overcome these barriers. Advocacy for access to care on behalf of this vulnerable patient population will expand treatment access on a state and national level.