COVID-19 as a Catalyst for Ultra-Hypofractionated Radiotherapy in Early Breast Cancer: Trends, Predictors, and Estimated Cost Savings.

BACKGROUND

COVID-19 significantly impacted radiation treatment trends in early breast cancer. An ASCO survey showed a 40% shift worldwide toward ultra-hypofractionated (UHF) or radiation omission in eligible patients. This study examines UHF in the US during COVID.

MATERIALS AND

METHODS

NCDB was queried to identify early-stage breast cancer (ductal carcinoma in situ, T1N0, T2N0) treated with breast-conserving surgery and adjuvant radiation. UHF was defined as ≤10 fractions; extended radiation (eRT) was defined as >10 fractions. Pre-COVID (2015-2019) and COVID (2020-2021) periods were compared. Logistic regression identified factors associated with UHF. Treatment costs were estimated using Centers for Medicare and Medicaid Services' data.

RESULTS

A total of 528,553 patients were included (358,673 pre-COVID, 169,880 during). UHF increased from 4.8% pre-COVID to 11.4% during COVID (P < .001), with the largest increase (58.9%) from 2019 to 2020. Older patients (≥70) had higher UHF rates during COVID than younger patients (17.0% vs. 9.4%, P < .001). Pre-COVID, UHF was similar across academic and community centers; however during COVID, UHF was more frequent at community centers (12.7% vs. 10.1%, P < .001). UHF was more likely during COVID (OR 2.49, 95% CI, 2.44-2.55), in patients ≥70 (OR 1.63, 95% CI, 1.60-1.67), with increased comorbidities (OR 1.18, 95% CI, 1.12-1.23), T1 disease (OR 1.52, 95% CI, 1.38-1.68), and at community centers (OR 1.15, 95% CI, 1.13-1.18). UHF had a median treatment cost of $2289 versus $5032 for eRT, with an estimated $30 million saved during COVID.

CONCLUSION

UHF increased during COVID, leading to substantial cost savings, but eRT remained the predominant approach. Further follow-up will determine if these trends persist post pandemic.