Use of Radiation Therapy for the Treatment of Breast Cancer in 2019 Versus 2020

Abstract

Purpose: The COVID-19 pandemic disrupted medical care. Little is known about how radiation therapy (RT) ordering behavior changed during the pandemic. This study examined (1) whether there was a change in the rate at which orders for lumpectomy were followed by orders for RT and (2) whether there was a change in the percentage of RT orders for hypofractionated (HF) RT rather than conventionally fractionated (CF) RT. Methods and Materials: Prior authorization order data from 2019 and 2020, pertaining to patients with commercial and Medicare Advantage health plans, were reviewed to determine whether patients had an order for RT in the 90 days after lumpectomy and if it was for CF or HF RT. Univariate analyses were conducted using χ2 tests, and adjusted analyses were conducted using multivariate logistic regression, controlling for patient age, urbanicity, local median income, region, if the lumpectomy facility was academic, and if the lumpectomy facility was a hospital. Results: In 2019, 47.7% of included lumpectomy orders (2200/4610) were followed by an RT order within 90 days, in contrast to 45.6% (1944/4263) in 2020 (P = .048). Of the RT orders meeting this study's definition of CF or HF, 75.3% of orders placed in 2019 (1387/1843) and 79.0% of orders placed in 2020 (1261/1597) were for HF (P = .011). Adjusted analysis found patients receiving a lumpectomy order in the first quarter of 2020 had significantly reduced odds (odds ratio, 0.84; 95% CI, 0.71-0.99) of receiving an order for RT after lumpectomy, relative to those with orders placed in the first quarter of 2019. Adjusted analysis likewise found significant evidence of increased use of HF RT during the pandemic. Conclusions: In the population examined, physicians were less likely to order RT after lumpectomy in 2020 than in 2019, and if they did, were more likely to order HF RT.