Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
2887 - National Trends in Radiation Fractionation for Breast Cancer in Relation to the COVID-19 Pandemic
Presenter(s)
Manish Suryapalam, MD, BS - UCLA David Geffen School of Medicine/UCLA Medical Center, Los Angeles, CA
M. Suryapalam1, R. Ariani2, and M. Xiang2; 1UCLA David Geffen School of Medicine/UCLA Medical Center, Los Angeles, CA, 2Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
Purpose/Objective(s):
Radiotherapy fractionation for breast cancer has evolved with increasing adoption of moderate and ultra-hypofractionation supported by randomized trials. The COVID-19 pandemic also encouraged shorter treatment regimens to reduce treatment visits, but the extent to which it accelerated adoption of these regimens remains unclear. We evaluated national fractionation patterns from 2018–2019 (pre-pandemic), 2020–2021 (early pandemic), and 2022–2023 (late pandemic) to assess whether pandemic-era changes were transient or persistent. The hypothesis is that the COVID-19 pandemic was associated with increased use of ultra-hypofractionation (UHF) and decreased use of conventional fractionation (CF) relative to moderate hypofractionation (MHF) for whole-breast radiotherapyMaterials/Methods:
Patients with breast cancer diagnosed from 2018–2023 were identified from the National Cancer Database. Eligible patients had pTis–T2, pN0 or pNX, M0 disease treated with breast-conserving surgery followed by postoperative whole-breast external beam radiation. Fractionation was categorized as ultra-hypofractionation (5 fractions, UHF), moderate hypofractionation (15–16 fractions, MHF), and conventional fractionation (25–28 fractions, CF). Temporal trends were evaluated across pre-pandemic (2018–2019), early pandemic (2020–2021), and late pandemic (2022–2023) periods. Multinomial logistic regression assessed associations between fractionation and diagnosis period, patient, tumor, and facility characteristics.Results:
A total of 261,199 patients met inclusion criteria (Table). Using MHF as the reference, CF declined over time, with lower odds during the early pandemic versus pre-pandemic (adjusted odds ratio [aOR] 0.48, 95% CI 0.46–0.50, p < .001) and further decline in the late pandemic period (aOR 0.52, 95% CI 0.50–0.55, p < .001). In contrast, UHF increased markedly during the early pandemic (aOR 43.50, 95% CI 34.5–58.8, p < .001) and continued to rise in the late pandemic period (aOR 2.65, 95% CI 2.52–2.78, p < .001). Increasing age, greater distance to facility, and treatment at academic centers were also associated with higher UHF use.Conclusion:
Breast radiotherapy fractionation shifted markedly during the COVID-19 pandemic. The largest change occurred with UHF during the early pandemic, when efforts to reduce patient visits and maintain treatment capacity likely accelerated adoption of shorter regimens. These changes were not transient; UHF continued to increase during the late pandemic period while CF declined, indicating a sustained shift in clinical practice. Together, these findings suggest the pandemic catalyzed more rapid implementation of shorter regimens already supported by emerging randomized evidence.| Fractionation Distribution by Time Period (%) | ||||
| Pre-Pandemic (2018-2019) | Early-Pandemic (2020-2021) | Late-Pandemic (2022-2023) | Overall | |
| CF | 15.6 | 8.0 | 4.2 | 9.4 |
| MHF | 84.3 | 88.6 | 86.7 | 86.5 |
| UHF | 0.1 | 3.4 | 9.1 | 4.1 |