A poster titled, “Use of Radiation Therapy for the Treatment of Breast Cancer in 2019 versus 2020” has been presented at the 2022 American Society for Radiation Oncology (ASTRO) Annual Meeting. The study was conducted as a part of the outcomes research collaboration between HealthHelp and Humana, and utilized data provided by the organizations.
Although prior claims-based research has shown that patients received more conservative care in response to the COVID-19 pandemic, little is known about how radiation therapy (RT) ordering behavior changed during the pandemic. To help answer this question, we examined whether the rate at which orders for lumpectomy were followed by orders for RT changed from 2019 to 2020, and whether there was a change in the percentage of RT orders that were for hypofractionated (HF) RT, rather than conventional (CF) RT. While HF RT for the treatment of breast cancer had been in use prior to the pandemic, the need to conserve healthcare resources driven by the pandemic potentially could have furthered its adoption.
The analysis was performed using prior authorization order data pertaining to patients from one national organization’s commercial and Medicare Advantage health plans. Included patients were females, aged 18 to 89, who had an order for a lumpectomy in 2019 or 2020. Patients were excluded if they were not continuously enrolled in their health plan for 90 days following lumpectomy. Orders were reviewed to determine whether patients had an order for RT in the 90 days following lumpectomy. Orders were classified as HF if they were for 5 to 21 fractions, CF if they were for 28 or more fractions, and as neither if they were for other numbers of fractions. Univariate analyses were conducted using Chi-square tests, and adjusted analyses were conducted using multivariable logistic regression, controlling for patient age, urbanicity, local median income (<$40,000, $40,000-$80,000, or >$80,000), region, if the designated lumpectomy facility’s name implied an academic affiliation, and if the designated lumpectomy facility was a hospital.
The patient population consisted of 4,689 patients meeting inclusion criteria in 2019 and 4,383 in 2020, for a total of 9,072. In 2019, 47.1% (2,208/4,689) of patients had an RT order following lumpectomy, versus 44.6% (1,953/4,383) in 2020, a significant difference (P=0.02). Of the patients receiving RT orders meeting the definition of HF or CF, 76.3% (1,475/1,933) of orders in 2019 were for HF, and 80.5% (1,383/1,719) of orders in 2020 were for HF, a significant difference (P<0.01). Adjusted analysis found that patients in 2020 were at significantly reduced odds (OR: 0.91; 95% CI: 0.83-0.99) of receiving an order for RT following lumpectomy, and among orders meeting the definition of HF or CF, there were significantly increased odds that the order was for HF (OR: 1.29; 95% CI: 1.10-1.52). Patient age, region, and receipt of an order for treatment at an academic facility were significantly associated with receipt of an order for RT. Patient age, local median income, and region were all significantly associated with whether CF versus HF RT was ordered.
Reflecting on the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., remarked, “The COVID-19 pandemic caused healthcare providers to rethink how healthcare is delivered and to become more conservative in their ordering behavior. While hypofractionated radiation therapy has long been known to be an effective means of treating breast cancer, and our own prior research has shown that its use is associated with better treatment adherence, this approach has been underutilized. Our latest study shows that during the period of resource scarcity that we experienced in 2020, there was more frequent use of hypofractionated radiation therapy than we had seen in the prior year.”
To learn more about ASTRO’s 2022 Annual Meeting, visit: https://www.astro.org/Meetings-and-Education/Micro-Sites/2022/Annual-Meeting