The American Society for Radiation Oncology (ASTRO) recently conducted an online survey of 222 US based, practicing radiation oncologists identified as practice leaders in ASTRO’s member database, finding that 100% of respondents continued to provide radiation therapy services during the early weeks of the coronavirus disease 2019 (COVID-19) pandemic.1
Once the threat of COVID-19 became evident, radiation oncology clinics adapted their safety protocols in order to continue caring for patients and protecting staff, including requiring masks for staff (99%) and patients (83%), screening patients at the clinic door (98%), social distancing (98%), increasing clinic sterilization and cleaning (95%), testing staff showing symptoms (93%), screening staff before each shift (91%), and not allowing visitors (90%). However, 69% also reported experiencing limited access to or shortages of personal protective equipment (PPE).
“Safety has always been at the forefront of radiation oncology, and when the COVID-19 threat emerged, clinics quickly adapted their safety protocols to minimize exposure risk and protect their patients and staff,” ASTRO Board Chair Theodore L. DeWeese, MD, FASTRO, said in a press release.2 “The rapid adoption of masking, social distancing, and other protective measures meant that radiation oncologists largely have been able to be resilient and provide care without compromise throughout the initial months of this pandemic.”
Another important aspect of continuing care was found to be telehealth patient consultations. Nearly all respondents indicated that this telemedicine consultations were a new option for patients. In the survey, 89% of respondents said their clinics offered telemedicine options for consultations and follow-up visits.
However, despite the changes implemented, patient volume declined substantially at most radiation therapy clinics. Overall, 85% of the survey respondents reported declines in the overall number of patients seen. On average, practices saw two-thirds of their usual patient volume. These decreases were reportedly due mostly to delayed or deferred treatment (82%) and fewer patients being referred for radiation therapy (81%) by other physicians.
Specifically, many clinics deferred some new patient visits, such as for those with benign disease. Deferrals were more likely at practices located in metropolitan areas (79%) than at those in non-metro or rural areas (49%). The remainder reported no change in scheduling new patient visits.
The survey also highlighted financial challenges caused by COVID-19. All survey respondents estimated their clinics would lose revenue, most within the range of a 21-30% loss. Moreover, freestanding radiation oncology clinics are anticipated to see a disproportionately higher financial decline, with 1 in 5 predicted to lose more than half of its annual revenue.
Even further, the majority of practices reported experiencing staff reductions, mainly due to declines in patient volume (49%) and increased family care responsibilities (28%). Notably though, few clinics had reductions due to COVID-19-related illness among staff members (11%).
“Although COVID-19 has presented us with unprecedented challenges and forced us to think anew, our goals as radiation oncologists remain unaltered,” said DeWeese. “We stand resilient and ready to care for our patients, today and always.”
Responses for the survey were collected from April 16-30, 2020. ASTRO indicated that this is the initial report of a longitudinal survey, and future reports will assess the changes over time.
1. ASTRO. COVID-19’s Impact on Radiation Oncology. ASTRO website. Published May 20, 2020. astro.org/ASTRO/media/ASTRO/News%20and%20Publications/PDFs/ASTROCOVID19Survey1-ExecSummary.pdf. Accessed May 20, 2020.
2. ASTRO survey: Fewer patient visits despite enhanced COVID-19 safety measures for radiation oncology clinics [news release]. Arlington, Virginia. Published May 20, 2020. astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2020/ASTRO-survey-Fewer-patient-visits-despite-enhanced. Accessed May 20, 2020.