Impact of the COVID-19 Pandemic on Prostate Cancer Radiotherapy Practice Patterns: A Northeast Regional Longitudinal Survey Study

PURPOSE/OBJECTIVE(S): During the COVID-19 pandemic, the National Comprehensive Cancer Network (NCCN) provided management guidelines for prostate cancer (PCa) patients undergoing radiation therapy (RT). It is unknown whether or not radiation oncologists adopted these treatment recommendations. We assessed whether Northeast (NE) radiation oncologists managed PCa differently or according to guidelines during the 2020 Spring and the 2020-2021 Winter surges, as this region was affected profoundly by both waves. MATERIALS/METHODS: 847 NE radiation oncologists were identified from the ASTRO membership directory. The NE region was defined as states of: CT, MA, ME, NH, NJ, NY, PA, RI, VT. A link to an anonymous electronic survey was disseminated with hypothetical PCa patient scenarios for RT during the COVID-19 pandemic to elucidate practice patterns. Eligible participants had to indicate they regularly treat PCa patients. The initial survey was distributed in early Summer 2020 to understand practice patterns during the Spring surge. During the COVID-19 Winter peak, participants who voluntarily provided their email addresses not linked to survey responses were recontacted to complete a follow-up (FU) survey. RESULTS: Of 847 initial survey invitations, 333 participants indicated that they did not treat PCa. Of the remaining 514 participants, 151 indicated that they treated PCa and fully completed the survey (30% response rate). The response rate among 100 participants for the FU survey was 68%. Among initial respondents, 59% practice in non-academic settings. For favorable intermediate-risk PCa scenarios, 55% of respondents elected to delay moderately/conventionally fractionated RT in the initial survey. In the FU survey, 75% of respondents were in favor of treating without delay. For unfavorable intermediate- and high-risk PCa scenarios after three months of androgen deprivation therapy (ADT), 53.4% elected to delay scheduled RT in the initial survey, while 85% would treat as planned in the FU survey. In the above scenarios, there was little consideration of a 5 fraction RT schedule. For the post-prostatectomy salvage scenario where no ADT was considered, 35% favored treating with 1.8-2 Gy per fraction without delay during the initial survey (3% favored 20 fractions); 60% elected to move forward with RT in the FU survey. CONCLUSION: This survey evaluated NE radiation oncology PCa practice patterns during the COVID-19 pandemic, finding that most physicians were in favor of delaying RT during the Spring surge, in concordance with the NCCN recommendation. Subsequently, the winter surge FU survey demonstrated that physicians were more comfortable treating without delay. This is likely attributed to increased health and safety guidelines, as well as policies in place to minimize exposure in radiation oncology departments.