September 9, 2026
COVID-19 Pandemic Accelerated Adoption of Shorter, Lower-Burden Breast Radiation Therapy, Medicare Study Finds
New study shows rapid shift toward evidence-based 5-treatment radiation courses reduced patient burden and lowered costs
The COVID-19 pandemic accelerated the adoption of shorter-course radiation therapy for women with early-stage breast cancer, leading to reduced treatment burden and lower healthcare spending, according to a new study published in the American Journal of Clinical Oncology. Harvey L. Neiman Health Policy Institute and University of Pennsylvania researchers found that use of ultra-hypofractionated whole-breast irradiation (UH-WBI), a five-treatment radiation regimen supported by clinical trial evidence, increased fivefold among Medicare beneficiaries following the onset of the pandemic.
Analyzing a national 5% sample of Medicare fee-for-service beneficiaries diagnosed with breast cancer between 2018 and 2021, investigators found that utilization of ultra-hypofractionated radiotherapy increased from 1.7% before the pandemic to 8.4% afterward, while use of conventional radiation schedules requiring 22 or more treatments declined from 23.2% to 16.4%. The study sample included 4,086 Medicare beneficiaries with newly-diagnosed, early-stage breast cancer treated with lumpectomy and post-surgical radiation therapy.
“The pandemic created an urgent need to reduce patient exposure risk and minimize healthcare visits, but this study shows that this need translated to beneficial clinical changes,” said co-lead author Andre A. Konski, MD, MBA, MA, MSc, FACR, FASTRO, Professor of Radiation Oncology at the Perelman School of Medicine and the Chester County Hospital, University of Pennsylvania. “In the face of such pressure, and with clinical evidence supporting a more convenient and equally effective treatment approach, practice patterns can change much more rapidly than many would expect.”
The transition is notable because adoption of previous evidence-based hypofractionated breast radiation regimens occurred gradually over many years despite strong clinical evidence demonstrating equivalent outcomes. In contrast, use of five-fraction “ultra-hypofractionation” treatment schedules increased rapidly following publication of key clinical trials and pandemic-era guidance encouraging shorter treatment courses when appropriate.
“Our analysis found that the largest increases in ultra-hypofractionated treatment occurred among patients who may benefit most from fewer healthcare encounters, including adults age 80 and older and those with a high burden of chronic illness. Patients diagnosed after the onset of COVID-19 received nearly two fewer radiation treatments on average and completed therapy approximately three days sooner than patients treated before the pandemic,” explained co-lead author YoonKyung Chung, PhD, Principal Economic and Health Services Researcher at the Neiman Health Policy Institute.
“These findings demonstrate the potential for healthcare systems to more rapidly adopt high-value care when evidence, professional guidance, and clinical necessity align,” said Elizabeth Rula, PhD, senior author and Executive Director of the Neiman Health Policy Institute. “Importantly, the shift toward shorter treatment regimens reduced burden on patients while also generating measurable savings for the Medicare program.”
Researchers estimated that the change in radiation treatment patterns lowered average radiotherapy spending by approximately $412 per patient. Across all treatment regimens studied, average radiotherapy costs ranged from $1,848 for ultra-hypofractionated treatment to $8,820 for conventional schedules, highlighting the substantial economic implications of expanding use of evidence-based shorter-course therapy.
The study also identified regional differences in adoption. Patients residing in the Northeast experienced the greatest increase in use of ultra-hypofractionated radiation therapy following the onset of the pandemic. Additionally, while utilization increased significantly among White patients, similar increases were not observed among Black patients, suggesting opportunities for future research on equitable access to emerging treatment approaches.
The authors conclude that the rapid uptake of ultra-hypofractionated breast radiotherapy demonstrates that meaningful practice transformation is achievable and may offer a roadmap for accelerating adoption of future evidence-based innovations in cancer care.
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, BlueSky or LinkedIn.