Utilization of radiotherapy and hypofractionated radiotherapy in Japan: long-term trends and the influence of COVID-19 pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, a short-term decline in radiotherapy use was reported. In this study, we investigated long-term changes in the use of radiotherapy and hypofractionated radiotherapy before and after the COVID-19 pandemic period in Japan and assessed whether the pandemic influenced the adoption of hypofractionation. We obtained data for analysis from the National Database Open Data for fiscal years (FYs) 2014 to 2023. For the 5 years from FY2019 to FY2023, with detailed monthly data available, we used interrupted time series (ITS) analysis to examine changes in the level and slope of claims at the boundaries of the baseline, pandemic and post-pandemic periods. During the 10-year study period, the number of radiotherapy claims increased by an average of 1.6% per year. In FY2020, the peak of the COVID-19 pandemic, the number of radiotherapy claims decreased by 2.0% compared to the previous year. The number of claims for extra fees for hypofractionated radiotherapy for breast and prostate cancer showed a steady increase, except for a temporary decline around the April 2022 policy change in payment requirements for prostate cancer. In the ITS analysis, there were no significant changes in the level and slope of claims for radiotherapy and extra fees for hypofractionated radiotherapy at the onset of the pandemic. In conclusion, the impact of the COVID-19 pandemic on the utilization of radiotherapy in Japan was minimal, and the use of hypofractionated radiotherapy showed a steady increase throughout this period.