PO-1451 Unintentional effects of societal restrictions during the SARS-CoV-2 pandemic on referral for RT B. Mortensen1

Abstract

Purpose or Objective: During the SARS-CoV-2 (COVID-19) pandemic, the Danish Healthcare system has remained fully open for all acute or life-threatening conditions. However Skovlund et al. 2020 has shown 33% fewer cancer cases in Denmark during the first three months of the national lockdown, initiated on March the 11th, compared to the previous five years. The purpose of this study is to analyse and quantify this over the first year of the pandemic in respect to changes in referral for radiotherapy (RT) for curative treatment for early breast cancer (BC) in one Danish radiotherapy centre. Materials and Methods: The monthly number of referrals for curative RT for BC ranging from April 2020 to February 2021 was analysed and compared to the previous 25 months to test for statistically significant changes. Results: The median monthly number of referrals for curative RT for BC for the 25 months prior to the lockdown was 51 with a standard deviation of 6.8. For the 11 months following the lockdown, the median monthly number of referrals for curative RT for BC was 41 with a standard deviation of 9.3 (decline of 19.6%). This was found statistically significant using Mann-Whitney U-test with a p<0.001 (one-tailed). (Figure Presented) Analysis from the Danish Health Authorities (February 2021) ranging from week 2 to week 52 of 2020 showed a decline in mammography starting in March with the onset of the COVID-19 pandemic in Denmark. After lifting the societal restriction, the activity showed a tendency towards only partial normalisation. The median decline of the 43 weeks following the first 9 weeks of 2020 in the hospital’s catchment area corresponded to 18.2%.. (Figure Presented) Dividing the curative BC referrals into two subgroups: a) local-only RT or b) loco-regional RT showed that the decline in referrals where mainly driven by the first group. Median monthly referrals dropped from 34 to 24 and from 20 to 18 respectively with declines of 29.4% and 10.0%. Monthly referrals in both subgroups where found to correlate with the total number of referrals before the lockdown (Pearson Correlation Coefficient – both with p<0.001), while only the first subgroup correlated after the lockdown (p<0.001 and p≈0.065 respectively). Conclusion: Although no acute nor life-threatening activities in the Danish Healthcare system during the COVID-19 pandemic have been closed nor reduced in activity, significant declines in patients diagnosed with cancer have been reported. Analysis of local referrals for one radiotherapy centre for curative RT for BC supports this, with a suggested decline of around 20% cumulative for the 11 months period following the COVID-19 pandemic onset in Denmark. Further analysis suggests that this decline was mainly driven by the subgroup of patients referred for local-only RT of the conserved breast. This might indicate that patient behaviour during the societal restriction have had unintended effects in early diagnosis of BC by voluntarily participations in national mammography screening program.