COVID-19 Testing Trends: Pre-Radiation and Throughout Cancer Care

PURPOSE/OBJECTIVE(S): Timely care is critical for individuals diagnosed with cancer—despite the ongoing COVID-19 pandemic—as delays adversely affect cancer outcomes. Patients presenting for radiotherapy (RT) at a single institution who underwent COVID-19 screening procedures prior to RT were analyzed regarding treatment delays and disparities. MATERIALS/METHODS: Our institution is an urban multidisciplinary cancer center. In April 2020, our Radiation Oncology department implemented universal COVID-19 screening protocols prior to RT initiation (with possible patient opt-out) to ensure patient/staff safety. Patients did not start RT until testing negative. We collected patient demographics and COVID-19 testing information on patients planned for RT from April to October 2020. We studied trends of other lifetime COVID-19 testing that these patients received to evaluate for overall delays. Summary statistics were analyzed within a data collection web application. RESULTS: 177 consecutive patients with cancer were scheduled to begin RT. 15 (8.5%) declined pre-RT COVID-19 testing and proceeded to RT. Of patients who consented to pre-RT testing, 99 (61.1%) were female; mean age was 60.6 (range 24-94). Most patients were Black (n = 98, 60.5%). 61 (37.7%) and 41 (25.3%) were insured through Medicare and Medicaid, respectively. Common primary cancer sites were breast (n = 52, 32.1%), prostate (n = 27, 16.7%), and lung (n = 23, 14.2%). 58 (35.8%) patients presented with metastatic disease; the most common metastatic sites were bone (n = 26, 44.8%) and brain (n = 12, 20.7%). Most patients received external RT (n = 152, 93.8%), primarily adjuvant (n = 66, 40.7%) and palliative (n = 59, 36.4%) RT. One (0.6%) asymptomatic patient tested "presumptive positive" for COVID-19 pre-RT. The patient was COVID-19 negative on immediate repeat testing and proceeded to RT. Overall, the 162 patients who consented to pre-RT testing received 549 total lifetime COVID-19 tests. Most of these patients received palliative RT (n = 219, 39.9%), followed by adjuvant (n = 199, 36.2%) and definitive RT (n = 101, 18.4%). Mean number of total COVID-19 tests per patient was 3.4 (range 1-14). Only 32 patients (19.8%) were administered a solitary pre-RT COVID-19 screening test. 24 (14.8%) patients had at least one positive COVID-19 test over the study period. In total, 32 (5.8%) positive COVID-19 test results were documented; 11 patients (6.8%) experienced a mean RT delay of 4.0 (range 3-8) weeks until testing negative. Other care delays included surgical/diagnostic procedure delays (n = 4), delayed presentation due to COVID-19 fears (n = 2), and travel restrictions (n = 1). CONCLUSION: The majority of patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, delays prior to radiation oncology consultation due to diagnostic workup, imaging, or biopsies, as well as testing positive for COVID-19, could intensify underlying disparities affecting our urban patient population.