Impact of the COVID-19 Pandemic on Radiation Oncology Consult Volumes Within a Multi-Site Academic Practice

PURPOSE/OBJECTIVE(S): Cancer care has been significantly impacted by the COVID 19 pandemic; however, a comprehensive understanding of the downstream effects of the pandemic on radiation oncology practice in the United States has not been well quantified. We sought to quantify the differences in radiation consult volumes across varying disease sites and practice locations within our National Cancer Institute (NCI) designated Comprehensive Cancer Center, at time points preceding and during the COVID 19 pandemic. The purpose of this study is to identify potential gaps in care for specific disease sites that could addressed in the future. MATERIALS/METHODS: We collected new patient referral data from three clinical radiation oncology sites for the 2019 calendar year and the 2020 calendar year. Overall new patient referrals for 2019 and 2020 were analyzed and compared as well as consult volume for each disease site. RESULTS: In 2019, there was a total 4,284 overall consults and in 2020 there was a total of 3,442 consults. This is a 20% reduction in consults over a 12-month period. The month of April had the most significant decrease in consults with a total of 357 consults in April 2019 compared to a total of 179 consults in April 2020 (50% reduction). The month of February had the least reduction with 329 total consults in 2019 compared to a total of 313 consults in 2020 (5% reduction). There was a decrease in consult volumes for all tumor sites with the exception of following tumor sites which saw an increase in consult volumes: colon (55.6%), kidney &renal pelvis (15.8), larynx (32.7%), oral cavity (7%), Non-Hodgkin's Lymphoma (9.9%), other head & neck (13.9%), and thyroid cancer (36.4%). Breast and prostate cancer had the greatest absolute change in consult volume loss (32.6%, 29.3% respectively). Oral tongue cancer was the sole tumor site that had no change in consult volume across the study period. CONCLUSION: The ramifications of COVID-19 will be seen in the practices of clinicians, cancer centers, and the experiences of patients and their families for years to come. We found a 20% overall reduction in new patient referrals for 2020. The most significant absolute change in volume loss was seen in breast and prostate cancer. Head and neck cancer referrals were the most minimally impacted, with some increases in referrals during the study period which could possibly be related to limited surgical resources necessitating non-operative treatment. Further studies are needed to more comprehensively understand the impact of the COVID 19 pandemic on radiation oncology practice.