Impact of COVID 19 Pandemic on Radiation Oncology Care Path Time

PURPOSE/OBJECTIVE(S): We seek to investigate the impact of the COVID19 pandemic on the radiation oncology care path timeline. We hypothesized that the COVID19 pandemic would result in increased time to complete the care path from simulation to start of radiation. MATERIALS/METHODS: Care path data of patients treated at a single institution were included for 3 epochs: Pre COVID (July 2019 – March 2020), C1 [PreV] (April 2020 – Dec 2020), and C2 [PostV] (Jan 2021 – September 2021). The following tasks in the care path were evaluated: simulation start time, contours completed, physician review, plan finalization, IMRT/IMPT QA, and radiation treatment start. Time stamps of completion of tasks in the radiation treatment planning care pathway were extrapolated and used to create 9-time intervals. Demographic, tumor, and treatment characteristics were gathered to stratify patients. Patients with care path times greater than 25 days were excluded from the analysis. Numerical variables are summarized using mean and standard deviation while categorical data is summarized using counts and percentages. The ANOVA test is used to compare means in RT planning times between time epochs. RESULTS: A total of 3557 patients were included in the study analysis: 1095 PC, 1105 C1, and 1357 C2. There were improvements in multiple car path intervals following the start of the pandemic. Across epochs, the mean time from simulation to RT Start was 10.5 days (10.9 PC, 10.3C1, and 10.3 C2) (p =0.008). The mean time from simulation to plan finalization was 5.5 days (5.6 PC, 5.7 C1, 5.2 C2, p =0.008). The mean time for plan review to start time was 5.5 days (5.7 PC, 5.2 C1, and 5.5 C2) (p=0.010). Contour completion to radiation start time was significantly shorter after the pandemic (8.8 PC vs. 8.4 C1 vs. 8.4 C2, p =0.046). The mean time from physician review to IMRT/IMPT QA was 1.7 days (1.8 PC, 1.7 C1, 1.5 C2, p = 0.007). Physician review to RT start took a mean time of 5.5 days (5.7 PC, 5.2 C1, 5.5 C2, p = 0.010). Plan finalization to IMRT/IMPT QA took a mean time of 1.1 days (1.2 PC, 1.1 C1, 1.0 C2, p = 0.01). IMRT/QA to RT start took a mean time of 4.4 days (4.6 PC, 4.0 C1, and 4.5 C2, p =0.002). The mean time from plan finalization to RT start was 5.0 days (5.2 PC, 4.6 C1, 5.0 C2, p = 0.004). There were no significant differences in simulation to contour time (p =0.181) and physician review completion to plan finalization (p =0.223) CONCLUSION: The COVID19 pandemic has been a disruptive force in the management of patients in Radiation Oncology. However, we demonstrate improved efficiency in care path completion as we entered into the pandemic. Further investigation into care path efficiency is important for provider and patient satisfaction.