Dramatic change to radiation therapy in the UK with Covid-19

During the first wave of the coronavirus pandemic in the United Kingdom, dramatic changes were seen in the provision of radiation therapy for cancer.

A much shorter course of radiation therapy was offered, treatment was postponed in a safe place, and some increase was seen to compensate for the decline in surgical capacity.

Experts believe that this change reflects the impressive adaptation of services by the NHS and is likely to have a moderate overall impact on cancer outcomes.

A new study led by the University of Leeds and attended by the British Public Health Services and the Royal College of Radiologists found that radiation therapy courses decreased by 19.9% ​​in April, 6.2% in May, and 11.6% in June 2020. It has become clear. Comparison with the same month of the previous year.

These reductions correspond to more than 3,000 fewer radiation therapy courses than expected between March 23 and June 28, 2020 *. However, the missed course was likely due to the postponement, and the risk of postponement was considered low. However, in June, the decline in the number of courses seems to reflect a worrisome decline in the number of patients diagnosed with cancer.

This new study was the first to assess the impact of a pandemic on radiation therapy services in the United Kingdom and was published today in The Lancet Oncology.

Breast cancer treatments have changed rapidly. This was partially made possible by the results of UK trials published when the pandemic occurred. The study showed that a one-week course was as effective as a three-week course for many patients.

Surprisingly, the use of shorter treatment courses increased from only 0.2% of all breast cancer radiotherapy courses in April 2019 to 60.0% of all courses in April 2020.

Switching to shorter treatment courses was also seen in other types of cancer and helped maintain patient safety and service performance during the pandemic.

For some cancer types, the use of radiation therapy courses has increased significantly compared to the previous year. Radiation therapy for bladder cancer increased by 143.3% in May, esophageal cancer increased by 71.3%, and intestinal cancer increased by 36.3% in April.

These types of cancer are often treated by surgery. Radiation therapy may have resulted in these timely increases to provide alternative treatments or means to safely delay and to keep patients safe when surgery is not possible due to a pandemic. There is sex.

Radiation therapy guidance during a pandemic

About one in three cancer patients in the UK receive radiation therapy as part of their treatment. Radiation therapy can be used to try to treat a patient’s cancer or to treat pain or other symptoms when curative treatment is not possible.

Treatment is often given using daily target doses of radiation therapy for several weeks. Each cancer is different, and the course of radiation therapy depends on the type of cancer and the purpose of the treatment.

When the first wave of Covid-19 struck the United Kingdom in March and April 2020, national and international recommendations were soon issued to ensure the safe and effective use of radiation therapy. I did. The Royal College of Radiologists helped coordinate the development and publication of many of these guidelines, and researchers at the University of Leeds contributed to many of these guidelines.

Dr. Katis Spencer, a University Academic Clinical Fellow at the University of Leeds and a clinical oncologist at the NHS Trust at the University of Leeds, said: The lead author of the new study: “Radiation therapy is a very important treatment option for cancer, and our study showed that the NHS in English had a rapid change in the way radiation therapy was used.

“It’s impressive to see the data strictly follow the guidelines published at the beginning of the pandemic. For cancers such as breast and bowel cancer, shorter and more to achieve similar results for patients. Intensive treatment was given.

“When treatment delays are safe, such as prostate cancer, delays were used to reduce the risk of exposure to the coronavirus, which was especially important for older patients who were more vulnerable to the virus. ..

“In other cases, such as head and neck cancer and anal cancer, we found that the number of radiation treatments did not change much in the first wave. It is important that these treatments are not delayed. So I was really relieved. “

Researchers examined the number of radiation treatments performed within the UK NHS between February and June 2020, taken from the UK Public Health Service National Radiation Therapy Dataset. They examined the effects of the coronavirus pandemic and blockade by comparing the number and length of radiation therapy courses to the same period in 2019.

The largest reduction in treatment was seen in patients age 70 and older (34.4% reduction in April 2020). This may reflect concerns that the patient’s vulnerability to the risk of coronavirus outweighed the low risk expected from delaying treatment in some settings. For example, treatment for prostate cancer in April 2020 decreased by 77.0% year-on-year, and treatment for nonmelanoma skin cancer decreased by 72.4% in the same month.

Dr. Tom Roques, Director of Clinical Oncology Specialists at the Royal College of Radiologists, said: “This study shows the incredible speed at which radiation therapy services within the NHS have been able to adapt treatment patterns that help protect patients. Cancer while coping with the decline in surgical capacity due to global pandemics. ..

“Despite the strong pressure on the NHS, we were able to effectively adapt radiation therapy treatments, find alternative treatment options where possible, and continue to be the world’s leading standard of patient care.

“In the midst of the current Covid-19 surge, the NHS’s capabilities are under even greater stress, but the cancer team has leveraged all of last year’s clinical experience and innovation to provide radiation therapy services. We continue to function and provide the best possible care. Patients. “

The research team hopes that their findings will help healthcare providers understand the indirect consequences of pandemics and the role of radiation therapy services in minimizing their effects.