Treatment Delays in Radiation Oncology Patients During the COVID-19 Pandemic: A Los Angeles Safety-Net Hospital Experience

PURPOSE/OBJECTIVE(S): In December 2020, Los Angeles County became an epicenter of the COVID-19 pandemic in the US. This study aimed to assess the incidence of treatment delays in patients who tested positive for SARS-COV-2 while undergoing evaluation for radiation therapy at a Los Angeles safety-net hospital. MATERIALS/METHODS: We reviewed our departmental radiation oncology database for all patients seen in consultation from March 2020 to February 2021 and identified patients who tested positive for SARS-COV-2 while undergoing initial evaluation or radiation treatment. Treatment delays were quantified as days of delay from consult to CT simulation, days of delay from CT simulation to radiation treatment or any breaks in radiation treatment due to COVID-19 diagnosis causing rescheduling of appointments. We also collected data on patient demographics, cancer diagnosis and staging, medical comorbidities, and severity of patients' COVID-19 illness as defined by the NIH. All statistics are descriptive. RESULTS: From March 2020 to February 2021, a total of 855 unique patients were seen in consultation in the radiation oncology department. Twenty-six patients (3.51%) were identified as SARS-COV-2 positive during initial evaluation for radiation therapy or during treatment. Median age of patients diagnosed with COVID-19 was 59 years old (interquartile range 53 - 67 years). Treatment delays occurred in 11 patients (42.3%) of patients diagnosed with COVID-19. All patients diagnosed with COVID-19 were Latino or Black. The mean and median number of days delayed for patients who experienced treatment delays were 22.3 days (standard deviation: 13.3 days) and 19 days (interquartile range 11 - 25 days) respectively. Eighteen patients (69.2%) had asymptomatic or mild COVID illness. Eight patients (30.8%) had moderate to critical illness. Six patients were hospitalized for COVID-19 treatment and 2 patients died before receiving radiation therapy. Twenty-one of 26 patients (80.8%) had medical co-morbidities such as hypertension, diabetes, or obesity. CONCLUSION: From March 2020 to February 2021, a low proportion of patients seen in the radiation oncology department at a Los Angeles safety-net hospital tested positive for SARS-COV-2 with minor delays on radiation treatment. All patients who tested positive for SARS-COV-2 were Latino or Black. Long-term follow up is needed to assess the impact of COVID-19 and its treatment delays on oncologic outcomes.