Mitigation strategies to balance the risk of COVID-19 infection against oncologic risk in breast cancer patients undergoing radiotherapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiotherapy by oncologic risk and omission or deferral of radiotherapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers, and preserves resources. Herein we present our early response and adaptation of breast radiotherapy utilization during the COVID-19 pandemic at a large academic cancer centre in Canada.
A state of emergency was announced in Ontario on March 17, 2020 due to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast RT starts, type of breast RT, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019.
Following the declaration of emergency in Ontario, there was a decrease of 39% in radiotherapy starts in 2020 compared to 2019 (79 vs. 129, p<0.001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared to 2019 (46% vs. 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiotherapy were aged > 50 years in 2020, 66% (78/118) vs. 83% (132/160) in 2019, p=0.0027.
A significant reduction in breast radiotherapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiotherapy to patients associated with higher oncologic risk requiring RNI. A quick response to a health care crisis is critical, and is of particular importance for higher volume cancer sites where the potential impact on resources is greater.
The adaptation of breast radiotherapy utilization during the COVID-19 pandemic at a large academic cancer centre was evaluated. A significant reduction in breast radiotherapy starts was noted during the early response to the pandemic, with prioritization of radiotherapy to patients associated with higher oncologic risk. A rapid response to a health care crisis is critical, and is of particular importance for higher volume cancer sites where the potential impact on resources is greater.