UH-WBI use increased during COVID-19 pandemic

The COVID-19 pandemic may have led to faster adoption of shorter-course radiation therapy for women with early-stage breast cancer, according to research published September 10 in the American Journal of Clinical Oncology. 

The use of ultra-hypofractionated whole-breast irradiation (UH-WBI) increased by five times among women with Medicare following the start of the pandemic, wrote a team led by Andre Konski, MD, from the Harvey L. Neiman Health Policy Institute in Reston, VA. The team also observed a decrease in conventional radiation therapy use. 

“Although COVID-19 risk and restrictions likely contributed to the rapid change in protocol, the results indicate that a transition to new, evidence-based protocols in radiation therapy is possible,” the Konski team wrote. 

UH-WBI is a five-treatment radiation regimen, with clinical trial evidence supporting its use in treating early-stage breast cancer. Despite this evidence, adoption in the U.S. has been slow, the researchers noted. 

The COVID-19 pandemic began in the U.S. in 2020, with hospitals closing for non-emergency services such as cancer screening. In April 2020, five U.S. health organizations issued their collective expert opinion that during the pandemic, UH-WBI “may be considered” in some women needing post-lumpectomy radiation that does not require regional node irradiation. 

While the UK experienced faster adoption of UH-WBI during the early pandemic period, Konski and colleagues highlighted a lack of data on adoption in the U.S. The researchers studied trends in UH-WBI adoption in the U.S. during the COVID-19 pandemic. 

The study included retrospective data from 4,086 women, 25,04 of whom were in the pre-COVID group and 1,582 being in the post-COVID group. Both groups were similar in age, health status, and geographical location, the researchers noted. 

UH-WBI use increased five-fold from 1.7% in the pre-COVID group to 8.4% in the post-COVID group (p < 0.0001). On the other end, the conventional radiation therapy rate dropped from 23.2% of the pre-COVID to 16.4% of the post-COVID group (p < 0.0001). 

The largest increases in UH treatment happened in women who “may benefit most from fewer healthcare encounters,” the researchers found. These include women ages 80 and older and those with a high burden of chronic illness.  

“Patients diagnosed after the onset of COVID-19 received nearly two fewer radiation treatments on average and completed therapy approximately three days sooner than patients treated before the pandemic,” said co-lead author YoonKyung Chung, PhD, from the Neiman Institute in a prepared statement. 

The researchers also estimated a per-patient cost reduction of $412 when changing radiation treatment patterns to UH treatment. Across all treatment regimens studied, average radiotherapy costs ranged from $1,848 for UH treatment to $8,820 for conventional treatment. 

Finally, women living in the northeastern U.S. experienced the greatest increase in UH-WBI use following the onset of the pandemic. And while UH-WBI increased significantly among white women, the researchers did not observe these trends among Black women. 

The study authors called for future research to evaluate policies and other actions that may have led to the shift toward UH-WBI observed in the current study. They wrote that this “may accelerate the adoption of future advancements in radiotherapy or other medical treatments.” 

Read the full study here.