ASTRO Survey of Radiation Oncologists Shows Treatment Delays, Health Disparities Resulting From COVID-19 Pandemic


Thomas J. Eichler, MD, FASTRO, presented data during a media briefing from surveys of radiation oncologists treating patients with cancer through the COVID-19 pandemic.

More than half of radiation oncologists surveyed over the past year reported that people with cancer faced additional burdens due to the COVID-19 pandemic due to factors such as treatment interruptions and missed screening appointments, according to a briefing from the American Society for Radiation Oncology (ASTRO) and the National Coalition for Cancer Survivorship (NCCS) held on March 30, 2021.

Additionally, most physicians reported that access to and hesitancy surrounding the receipt of the COVID-19 vaccine represented a barrier to vaccination efforts at their clinics.

“ASTRO was part of a coalition led by the American Cancer Society and the National Comprehensive Cancer Network, working to encourage the American public to resume cancer screening and treatment, emphasizing that cancer won’t wait until the pandemic ends,” Thomas J. Eichler, MD, FASTRO, chair of the ASTRO Board of Directors, said in a presentation of the survey data. “ASTRO also supports COVID-19 vaccination for people receiving radiation therapy, in consultation with the radiation oncologist.”

The data were generated from surveys of 117 radiation oncologists taken in the months of April, May, and June 2020 and again in January 2021. The respondents represented a wide range of practitioners, including academic- and community-based settings in the results.

Notably, 66% of physicians reported that patients are presenting for treatment with more advanced cancers and that their existing patients experienced treatment interruptions due to the pandemic. Neglected cancer screenings because of the pandemic were reported by 73%.

“An essential point to make here is that both COVID-19 and cancer caused disproportionately more harm for black and other medically underserved populations,” Eichler said. “It is imperative that we recognize these disparities and to be mindful of health equity as we work to mitigate the harm caused by the pandemic.”

Enhanced safety protocols that were implemented in the early parts of the pandemic in large part remain in effect today, such as social distancing (100%), routine use of masks by staff (99%) and patients (98%), testing staff with symptoms of COVID-19 (97%), patients screening upon arrival (94%), increased sterilization in the clinic (93%), face shield use by staff (80%), and prohibition of visitors with patients (73%).

“The swift implementation of these enhanced measures is a major reason the patient access to radiation therapy had been sustained throughout the first year of the pandemic,” Eichler said. “One-hundred percent of the physicians surveyed said their radiation therapy networks remained open during multiple spikes in the pandemic and just 7% closed any other satellite locations.”

Physicians reported dramatically fewer treatment deferrals and postponements in early 2021 compared with Spring 2020. Rates of deferrals in April 2020 were at 75% versus only 12% in early 2021, with corresponding rates of postponements at 92% and 15%, respectively.

Telemedicine’s emergence during the early days of the pandemic remains popular in radiation clinics, with 85% of clinics offering this option to patients for routine care and 54% for new patient consultations. However, only 15% of clinics used telemedicine for clinician assessment of patients undergoing radiation treatment.

Another notable barrier of the pandemic is access to personal protective equipment (PPE), with 42% of radiation oncology clinics still reporting shortages in accessing these and other critical supplies. In addition, 72% of clinics experienced staff shortages at some point due to the COVID-19 pandemic.

“The pandemic is not affecting all clinics equally, with community-based private practices seeming to bear a disproportionately heavier burden,” Eichler said. “Private practice clinicians compared with academic practices were significantly more likely to report patients presenting with more advanced disease epidemic related frequent PPE shortages.”

Access to the vaccine was a barrier to vaccination efforts in 61% of private practices and 41% of those in the academic setting. Reluctance by staff and patients to receive the vaccines was reported by more than half of the respondents, and this effect was significantly more common in areas outside of major metropolitan areas.


Media briefing: COVID-19 & Cancer Care. American Society for Radiation Oncology and the National Coalition for Cancer Survivorship. Presented March 30, 2021.

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