Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada

Christine A Koch; Grace Lee; Zhihui A Liu; Fei-Fei Liu; Anthony Fyles; Kathy Han; Aisling Barry; Jennifer Croke; Danielle Rodin; Joelle Helou; Ezra Hahn; Naghmeh Isfahanian; Jane DeRocchis; Susanne Lofgren; Thomas G Purdie

doi:10.1016/j.adro.2020.06.002

Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada

Adv Radiat Oncol. 2020 Jun 19;5(4):749-756. doi: 10.1016/j.adro.2020.06.002. eCollection 2020 Jul-Aug.

Authors

Christine A Koch^{1

2}, Grace Lee^{1

2}, Zhihui A Liu^{3

4}, Fei-Fei Liu^{1

2}, Anthony Fyles^{1

2}, Kathy Han^{1

2}, Aisling Barry^{1

2}, Jennifer Croke^{1

2}, Danielle Rodin^{1

2}, Joelle Helou^{1

2}, Ezra Hahn^{1

2}, Naghmeh Isfahanian^{1

2}, Jane DeRocchis¹, Susanne Lofgren¹, Thomas G Purdie^{1

2}

Affiliations

¹ Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
² Department Radiation Oncology, University of Toronto, Ontario, Canada.
³ Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
⁴ Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.

Abstract

Purpose: Mitigation strategies to balance the risk of coronavirus disease 2019 (COVID-19) infection against oncologic risk in patients with breast cancer undergoing radiation therapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiation therapy by oncologic risk and omission or deferral of radiation therapy 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 radiation therapy utilization during the COVID-19 pandemic at a large academic cancer center in Canada.

Methods and materials: A state of emergency was announced in Ontario on March 17, 2020, owing to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast radiation therapy starts, type of breast radiation therapy, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019.

Results: After the declaration of emergency in Ontario, there was a decrease of 39% in radiation therapy starts in 2020 compared with 2019 (79 vs 129, P < .001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared with 2019 (46% vs 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiation therapy were aged >50 years in 2020, 66% (78 of 118) versus 83% (132 of 160) in 2019, P = .0027.

Conclusions: A significant reduction in breast radiation therapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiation therapy 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 effect on resources is greater.