Defining Radiation Treatment Interruption Rates During the COVID-19 Pandemic: Findings From an Academic Center in an Underserved Urban Setting

Purpose: Our purpose was to characterize radiation treatment interruption (RTI) rates and their potential association with sociodemographic variables in an urban population before and during the COVID-19 pandemic. Methods and Materials: Electronic health records were retrospectively reviewed for patients treated between January 1, 2015, and February 28, 2021. Major and minor RTI were defined as ≥5 and 2 to 4 unplanned cancellations, respectively. RTI was compared across demographic and clinical factors and whether treatment started before or after COVID-19 onset (March 15, 2020) using multivariate logistic regression analysis. Results: Of 2240 study cohort patients, 1938 started treatment before COVID-19 and 302 started after. Patient census fell 36% over the year after COVID-19 onset. RTI rates remained stable or trended downward, although subtle shifts in association with social and treatment factors were observed on univariate and multivariate analysis. Interaction of treatment timing with risk factors was modest and limited to treatment length and minor RTI. Despite the stability of cohort-level findings showing limited associations with race, geospatial mapping demonstrated a discrete geographic shift in elevated RTI toward Black, underinsured patients living in inner urban communities. Affected neighborhoods could not be predicted quantitatively by local COVID-19 transmission activity or social vulnerability indices. Conclusions: This is the first United States institutional report to describe radiation therapy referral volume and interruption patterns during the year after pandemic onset. Patient referral volumes did not fully recover from an initial steep decline, but local RTI rates and associated risk factors remained mostly stable. Geospatial mapping suggested migration of RTI risk toward marginalized, minority-majority urban ZIP codes, which could not otherwise be predicted by neighborhood-level social vulnerability or pandemic activity. These findings signal that detailed localization of highest-risk communities could help focus radiation therapy access improvement strategies during and after public health emergencies. However, this will require replication to validate and broaden relevance to other settings.