Quality Assurance of Radiotherapy During the Covid-19 Pandemic: Impact on Peer Review in 14 Regional Cancer Centers Across Ontario

PURPOSE/OBJECTIVE(S): Quality Assurance (QA) is an integral part of the delivery of Radiotherapy (RT). Peer review (PR) is an essential component of the QA process mandated by Cancer Care Ontario (CCO). The COVID-19 pandemic has caused significant disruptions to cancer care worldwide. We aimed to investigate PR rates across all regional cancer centers in Ontario during the pandemic. MATERIALS/METHODS: Using a provincial database maintained by CCO, PR data regarding completed curative and palliative RT courses were reviewed from December 2014 to November 2020. Peer reviews reported completed in March 2020 onward were considered to be completed during the pandemic. The monthly PR rates of 2019 were used as a baseline comparator. Wilcoxon signed-rank test (two-tailed) was used to determine significance in PR rates and courses of RT delivered. A P-value of < 0.05 was considered significant. RESULTS: A total of 24,936 radical courses and 18,759 palliative radiotherapy courses were completed in Ontario during the first 8 months of the pandemic. We found no difference in the average number of RT courses the year prior compared to during the pandemic for radical (3117/month vs 3382/month, P = 0.078) or palliative courses (2344/month vs 2227/month, P = 0.195). PR rates of radical RT were significantly decreased compared to the previous 12-month time period 86.1% vs 88.5% (95% CI: 0.6%-4.6% P = 0.014). Palliative RT also had a decrease in PR from 61.7% to 56.6% (95% CI:1.4%-7.2%, P = 0.016). In the 2 immediate months following March 2020, there was a decrease of PR rates with radical RT PR rates nadiring at 83% and palliative RT nadiring a 53% PR rate, the lowest since April 2016 and January 2018 respectively. This trend quickly reversed and PR rates increased in subsequent months. Analysis by disease site indicated a significant decrease compared to the prior year in disease site-specific PR rates for radical courses within breast (87.8% vs 90.3%, P = 0.16) and gynecologic (76.9% vs 84.1%, P = 0.049) disease sites respectively. Lung, Head and Neck, Gastrointestinal and CNS sites had no significant differences in PR rates when compared to the preceding year. CONCLUSION: Peer review rates had an initial decrease across regional cancer in both radical and palliative intent radiation. Overall, peer review rates remain modestly lower than the period immediately preceding the pandemic. All centers still maintained a high rate of PR during the initial 8 months of the COVID 19 pandemic.