Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Population-level impact of the COVID-19 pandemic on radiotherapy utilisation and fractionation for breast and lung cancer in NSW (145995)

Shalini K Vinod 1 2 3 , Karen Wong 1 3 , Vikneswary Batumalai 3 4 , Geoff P Delaney 1 2 3 , Gabriel S Gabriel 2 3
  1. Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia
  2. South Western Sydney Clinical School, University of NSW, Liverpool, NSW, Australia
  3. Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
  4. The George Institute for Global Health, Sydney, NSW, Australia

Aims

The COVID-19 pandemic prompted rapid changes to radiotherapy practice, including treatment prioritisation and greater use of hypofractionation. Whether these changes affected access to radiotherapy at a population level in NSW remains uncertain. We evaluated changes in radiotherapy utilisation (RTU), fractionation and treatment timeliness for breast and lung cancer in NSW.

Methods

We performed a retrospective population-based study using linked NSW Cancer Registry, radiotherapy hospital datasets. Patients diagnosed during the COVID-19 pandemic (2020–2021) were compared with a pre-pandemic cohort (2015–2019). RTU was defined as receipt of radiotherapy within one year of diagnosis. Fractionation analyses were restricted to curative/adjuvant treatment. Lung cancer surgical utilisation was also evaluated. Statistical comparisons used χ² testing.

Results

The pandemic had markedly different effects on breast and lung cancer management. Among 37,973 patients with breast cancer, RTU remained stable (60.4% pre-COVID-19 vs 60.5% during). Use of FAST-Forward (26 Gy in five fractions) increased from 0.1% to 4.6% (p<0.001), while use of other hypofractionated regimens increased from 61.8% to 76.7% (p<0.001). Mean time to breast radiotherapy was reduced (148 vs 143 days, p<0.001). In contrast, RTU for 25,279 patients with lung cancer declined (40.7% vs 38.1%, p<0.0001), coinciding with increased surgical utilisation (18% vs 20%, p<0.0001). Use of stereotactic ablative radiotherapy increased (8.1% vs 13.4%, p<0.001), together with other hypofractionated schedules (31.4% vs 35.7%, p<0.001), whilst time to lung radiotherapy remained unchanged.

Conclusions

Radiotherapy services demonstrated substantial resilience during the COVID-19 pandemic. Access to radiotherapy for breast cancer was maintained while hypofractionated schedules were rapidly implemented and treatment timeliness remained stable or improved. Although lung cancer RTU declined, this coincided with increased surgical management, suggesting a shift in treatment modality rather than reduced access to cancer treatment. These findings demonstrate rapid implementation of evidence-based practice during healthcare disruption and provide insights for future service planning.