COVID-19 Has Led To 'Alarming' Trend Toward More Advanced-Stage Cancer Diagnoses

Roughly one year into the COVID-19 pandemic, radiation oncologists continue to see indirect effects of the pandemic on their patients, according a survey by the American Society for Radiation Oncology (ASTRO).

Two-thirds of radiation oncologists surveyed in January/February 2021 said new cancer patients were arriving at their initial visit with more-advanced cancers than before the pandemic.

"The trend toward more-advanced disease, while alarming, does not automatically mean worse outcomes for patients," Dr. Thomas Eichler, chair of ASTRO's board of directors, said during a webinar announcing the survey results.

"Modern treatments, such as stereotactic radiation therapy or immunotherapy drugs, may offset some of the threat from advanced-stage cancers," he noted.

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A total of 117 radiation oncologists in 37 states participated in the online survey. Nearly three-fourths said patients have missed routine cancer screening and two-thirds said COVID has interrupted treatment for existing patients.

"The data are clear that people with cancer are facing additional burdens in these difficult times," Dr. Eichler said.

However, the latest ASTRO survey also found that clinics have largely stopped deferring or postponing radiation treatments. Only 12% of clinics reported deferring any new patient visits in January/February 2021 versus 75% in an earlier ASTRO survey conducted in April 2020.

And only 15% reported postponing treatment in January/February 2021, compared to 92% in April 2020. "Across the different waves of ASTO's survey, frequent delays dropped steadily over time. This 15% may have dropped even further in the few weeks since our survey was fielded," Dr. Eichler noted.

He said it's also important to note that postponements in radiation therapy in early 2021 were primarily for low-risk cancers or non-malignant disease that can be temporarily managed without radiation therapy in line with expert guidelines.

"Patients with higher-risk disease continued to receive uninterrupted access to radiation therapy throughout the pandemic," Dr. Eichler said.

One positive effect of the pandemic that is likely to stay is the widespread adoption of telemedicine, especially for routine care. "The vast majority of radiation therapy clinics now offer our patients telemedicine options for follow-up surveillance visits, and more than half do so for new patient consultations," Dr. Eichler said.

More than 40% of radiation oncologists reported ongoing problems with access to personal protective equipment (PPE), medical-grade hand sanitizer, and other critical supplies. More than half cited limitations in access to COVID-19 vaccines for staff and patients - as well as staff and patient hesitancy to get vaccinated when available.

Access and hesitancy issues were more common in radiation oncology practices outside major metropolitan areas and in private practice versus academic centers.

Safety has always been a "core value" of radiation oncologists and the survey also found clinics continue to use a wide variety of safety protocols, including social distancing, mask requirements, screening patients for COVID, prohibiting visitors in the clinics and increased clinic sterilization measures, Dr. Eichler noted.

"The swift implementation of these enhanced measures is a major reason that patient access to radiation therapy has been sustained throughout the first year of the pandemic," Dr. Eichler said.

—Megan Brooks

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