ASTRO survey finds rise in advanced-stage cancer

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The disruption of cancer screening programs during the COVID-19 pandemic has had a very real impact. In a recent survey by the American Society for Radiation Oncology (ASTRO), 66% of radiation therapy practice leaders said that new patients are presenting with more advanced-stage cancers.

In addition, 73% indicated that physicians in their practices are noticing that patients are not receiving cancer screenings, and 66% said that existing patients have experienced an interruption in their radiation therapy due to the pandemic.

These results show the consequences of pandemic-driven drops in cancer screening and diagnostics, especially for underserved populations, according to ASTRO Chair Dr. Thomas Eichler.

"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 statement from ASTRO.

ASTRO emailed the online survey to 509 radiation oncologists identified in its member database as medical directors of U.S.-based radiation oncology practices. Of these, 117 (23%) completed the survey online between January 15 and February 7.

In other survey results, ASTRO said that the following enhanced safety protocols remain widespread at radiation therapy clinics:

  • Social distancing in the clinic: 100%
  • Masking for patients and staff: 99%
  • Screening patients and staff for COVID-19 exposure: 95%
  • Increased sterilization: 93%
  • Face shields for staff during procedures: 80%
  • No-visitor policies: 73%

Clinics have largely stopped deferring or postponing radiation therapy treatments, according to ASTRO. Only 15% reported postponing treatment in January and February, compared with 92% in April 2020, according to the societies. Furthermore, 12% indicated that they were deferring any new patients in 2021, compared with 75% in the early weeks of the pandemic, ASTRO said.

In troublesome results, 40% of practices surveyed still reported difficulty accessing personal protective equipment (PPE), medical-grade hand sanitizer, or other critical supplies in the initial months of 2021, ASTRO said. Alarmingly, 59% of physicians said that vaccination efforts at their practice were limited by hesitation to receive the vaccine among staff, while 52% also noted hesitancy among patients. In addition, 53% of physicians said that these efforts were limited by access to the vaccine.

The survey also revealed that the pandemic isn't affecting clinics equally, the society said. Radiation oncologists at community-based private practices were more likely to report seeing advanced-stage cancers among their patients than those at university-affiliated clinics. What's more, PPE shortages and pandemic-related treatment interruptions were also more common at private practices, according to ASTRO.

In other findings, telemedicine is being used by 85% of clinics for follow-up visits and by 54% for new patient consultations, the society said. Only 12% used telemedicine for clinician assessments of patients undergoing radiation treatments, however.

Financial and operational challenges caused by the pandemic have continued to linger, ASTRO noted. Patient volume declined by an average of 73% at clinics and visits dropped by an average of 21%. In addition, 72% of practices had reduced staff at some point during the pandemic, according to the organization.

However, 100% of the responding physicians said that their radiation therapy networks remained open during multiple spikes of the pandemic. Only 7% closed any satellite locations, ASTRO said.

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