Breast Cancer Coverage from Every Angle

ASTRO 2021: COVID-19 Pandemic and Radiotherapy Patterns for Breast Cancer

By: Vanessa A. Carter, BS
Posted: Thursday, October 28, 2021

Donna Liao, MD, of the University of Toronto, Ontario, Canada, and colleagues examined the impact of the COVID-19 pandemic on changes in radiotherapy patterns of practice for patients with breast cancer. Presented during the 2021 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 2425), their results concluded that a large number of patients attended virtual visits and were treated with newer, hypofractionated dose schedules, although the total exclusion of adjuvant radiotherapy was “infrequently observed.”

A total of 306 and 271 patients with newly diagnosed breast cancer were enrolled in the 2019 and 2020 cohorts, respectively. Patient demographics, such as radiotherapy information, COVID-19 status, along with deviations from common practice due to the pandemic, were retrieved from medical records.

The median patient age of the 2019 cohort was 59, and the median patient age of the 2020 cohort was 58. In 2020, nearly all (96%) patient consultations were virtual, whereas all consultations in 2019 were in person. A total of 209 individuals were treated with adjuvant radiotherapy, including 56%, 36%, and 8% of patients receiving whole-breast irradiation, regional nodal irradiation, and partial-breast radiotherapy, respectively. In 2019 (n = 284), however, 60% underwent whole-breast irradiation, 31% received regional nodal irradiation, and 9% were administered partial-breast radiotherapy.

Compared with institutional practices prior to the COVID-19 pandemic, approximately 78% of cases experienced one or more deviations in radiotherapy practice as a result of the pandemic. An “altered dose/fractionation protocol” was the most common deviation (93%), including hypofractionated regional nodal irradiation (3% in 2019 vs. 97% in 2020) and the FAST Forward regimen (hypofractionated whole-breast radiotherapy/partial-breast radiotherapy; 0% in 2019 vs. 43% in 2020). A delay in the initiation of radiotherapy (11%) and the omission of radiotherapy (8%) were both recommended when the risk of COVID-19 outweighed the benefit of treatment. One patient experienced a deviation in radiotherapy because of a positive COVID-19 result.

Disclosure: The study authors reported no conflicts of interest.

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