Impact of the coronavirus disease 2019 pandemic on radiation oncology clinical decision making in a high-prevalence environment

Pendyala, Praveen; Goglia, Alexander G.; Mattes, Malcolm D.; Grann, Alison; Huang, David; Wagman, Raquel T.; Yehia, Zeinab Abou; Yoon, Jennifer; Ennis, Ronald D.

PURPOSE: To define how the coronavirus disease 2019 (COVID-19) pandemic impacted the role, timing, and delivery of radiotherapy in a high-prevalence region at the height of the initial U.S. outbreak. METHODS: We performed a retrospective review of all patients seen at three radiation oncology departments within the “XXXX” Health system in “XXXX” during the initial COVID-19 surge. Primary end points were to define and quantify COVID-related, radiation-specific care changes, and to identify predictive factors of experiencing COVID-related care changes. RESULTS: 545 cancer patients were seen during the study period, 99 of whom (18.1%) experienced >1 COVID-related care change. Radiation treatment (RT) delays were most common, accounting for 51.5% of all care changes. Physician-directed delays accounted for 41.2% of RT delays, while patient fears, COVID testing, and access barriers were responsible for 27.5%, 17.6%, and 13.7%, respectively. Patient age (p=0.040), intent of treatment (p=0.047), and cancer type (p<0.001) were significantly associated with experiencing a COVID-related care change, as we found that older, curative intent, and rectal cancer patients were more likely to experience care changes. On multivariate analysis, patient age remained significant when controlling for treatment intent and cancer type. CONCLUSION: Our study provides a perspective on how care was adapted to protect cancer patients during a pandemic while maximizing disease control. The positive correlation between age and likelihood of care changes may reflect extra precaution taken with older patients given their vulnerability to severe COVID illness; while the lower observed likelihood of COVID-related care changes among patients undergoing palliative RT may reflect either the more urgent needs addressed by palliative RT or may simply be logistical, as palliative radiation is often delivered in short courses with less exposure risk. It will be crucial to assess adaptations others have implemented and monitor how they impact patient outcomes.