A. Seo1, M. E. Inam2, C. R. Weil1, H. Song3, C. P. Anakwenze1, N. Ausat4, A. Mazul5, E. Y. Chiao6, and L. L. Lin1; 1Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 3University of Texas MD Anderson Cancer Center, Houston, TX, 4The University of Texas MD Anderson Cancer Center, Houston, TX, 5Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, 6Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): During the COVID-19 pandemic, radiation oncology departments faced hurdles in maintaining treatment continuity. This study aims to evaluate sociodemographic and clinical factors influencing radiation treatment delays pre- and post-pandemic, and to compare overall survival (OS) of patients treated in the pandemics first year with historical controls at our tertiary cancer center. Materials/
Methods: We analyzed electronic medical records of patients (pts) treated for cancer with curative intent at our large urban cancer center and regional satellites, comparing the pre-pandemic period (03/11/16-03/10/20) with the first year of the pandemic (03/11/20-12/30/20). Pts were selected based on treatment start, indexed by their first treatment. Statistical tests were used to assess factors associated with treatment delays and 24-month OS. Results: We analyzed data for 14,993 pre-pandemic and 2,781 post-pandemic pts. Post-pandemic pts did not have a significant difference in treatment delays (2.5% vs. 2.9%, P=0.46) or OS [86.6% (95% CI 83.5% - 89.8%) vs. 89.2% (95% CI 88.7%-89.7%), log-rank P=0.56] compared to pre-pandemic pts. Across cohorts, pts with treatment delays had worse OS than those who did not have delays [82.7% (95% CI 78.9%-86.6%) vs. 89.4% (95% CI 88.9%-89.9%); hazard ratio (HR) 1.82, 95% CI 1.42-2.34, P<0.001 adjusted for sociodemographic/clinical factors]. In pts with delays, pts post- vs. pre-pandemic had similar OS (76.8%, 95% CI 63.5%-92.3% vs. 83.2%, 95% CI 79.2%-87.4%, P=0.55). Post-pandemic pts who tested COVID-19 positive had similar OS to those who did not (93.3% 95% CI 81.5%-100% vs. 90.0%, 95% CI 88.5%-91.5%, P=0.59). On multivariable analysis, factors associated with increased treatment delay included area deprivation index (ADI) national rank in the bottom quartile (OR 1.51, 95% CI 1.13-2.02, p=0.006), COVID-19 positive test result (OR 24.22, 95% CI 7.75-67.61, p<0.001), total fraction count (OR 1.05, 95% CI 1.04-1.07, p<0.001), and various disease site sections in comparison to the Breast service (OR range 1.62-2.08). Factors associated with reduced treatment delays were married marital status compared to single (OR 0.59, 95% CI 0.44-0.81, P=0.001) and address >90 mi from the cancer center compared to <30 mi (OR 0.54, 95% CI 0.44-0.69, P<0.001). Age, gender, and race were not associated with treatment delay.
Conclusion: Pts treated in the first year of the COVID-19 pandemic did not experience significant radiation treatment delays or difference in 24-month OS. Increased treatment delay was associated with lower OS, underscoring the importance of treatment continuity. Marital status as single, lesser distance from the cancer center, higher ADI rank, certain disease sites, and COVID-19 positive test result were associated with increased treatment delay, highlighting areas for targeted interventions to improve access and outcomes.
