Survey Finds Pandemic Led to More Advanced-Stage Cancer Diagnoses

A recent survey of physicians has found that patients are arriving for cancer treatments with more advanced stage disease than before the COVID-19 pandemic, although treatment postponements and deferrals have subsided since the pandemic began.

In the survey, 66% of radiation oncologists said new patients are presenting with more late-stage cancers, whereas 73% said physicians in their practice are noticing that patients are not receiving cancer screenings. Many survey respondents also said existing patients experienced a disruption in their radiation treatment due to the pandemic. According to Thomas J. Eichler, MD, FASTRO, chair of the ASTRO Board of Directors, these impacts on patients with cancer may be even more significant in some communities.

“Because the pandemic and cancer cause disproportionately more harm for Black and other medically underserved populations, these rates may be even higher for some vulnerable communities,” Eichler said in a press release.

Enhanced safety protocols are also widespread in radiation therapy clinics, with survey respondents reporting nearly universal masking for both patients and staff (99%), social distancing in the clinic (100%), and screening patients and staff for COVID-19 exposure (95%). Furthermore, 93% of respondents reported increased sterilization, 80% said staff wear face shields during procedures, and 73% have no-visitor policies.

“Safety is the core of radiation oncology, and clinics were ready to adapt quickly and ramp up protective measures that keep their staff and patients safe from COVID-19 exposure,” Eichler said in the press release.

The investigators also found that clinics have largely stopped deferring or postponing radiation treatments, with only 15% reporting postponed treatments in January and February 2021, compared to 92% in April 2020. Similarly, 12% reported deferring any new patient visits in 2021, compared to 75% in the first weeks of the pandemic.

Despite the encouraging findings about resumed treatments, the researchers found that some early-pandemic difficulties continue. Four in 10 practices still said they struggle to access personal protective equipment (PPE), medical-grade hand sanitizer, or other critical supplies.

Many physicians also said that the COVID-19 vaccination efforts at their practice were limited by access to the vaccine and by staff members’ and patients’ hesitation to receive the vaccine. Furthermore, the investigators found that the pandemic is not impacting clinics equally.

Radiation oncologists at community-based private practices were more likely to report seeing advanced-stage cancers among their patients compared to clinicians at university-affiliated clinics. PPE shortages and pandemic-related treatment interruptions were also more common at private practices, whereas vaccine access and hesitation were more problematic in clinics located outside of major metropolitan areas and for community-based private practices compared to university-affiliated clinics.

Telemedicine is an ongoing practice, with 85% of clinics offering telemedicine options for follow-up surveillance visits and 54% using telemedicine for new patient consultations. Just 15% use telemedicine for clinician assessments of patients who are undergoing radiation treatments, according to the study.

Financial and operational challenges are also ongoing, with the survey finding that patient volume dropped at 73% of clinics due to the pandemic. Visits were down 21% on average and 72% of practices reduced staff at some point due to the pandemic, according to the survey. However, 100% of the physicians surveyed said their radiation therapy networks remained open during multiple spikes of the pandemic, and just 7% closed any satellite locations.

“One year into the COVID-19 pandemic, we already see the consequences of pandemic-driven drops in cancer screening and diagnostics,” Eichler concluded in the press release.

REFERENCE

COVID-19 pandemic has led to more advanced-stage cancer diagnoses, physician survey finds [news release]. ASTRO; March 30, 2021. https://preprod.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2021/COVID-19-pandemic-has-led-to-more-advanced-stage-c. Accessed April 2, 2021.