Dramatic changes in radiation therapy 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.

Much shorter Radiation therapy Courses were implemented, treatment was postponed in a safe place, and some increase was seen to compensate for the decline in surgical performance.

Experts say this change reflects the impressive adaptation of the service by the NHS and the overall impact is cancer Results can be modest.

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 less 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.

The new study is the first to assess the impact of Pandemic About radiotherapy services in the UK today Lancet Oncology..

The actual rapid change Breast cancer treatmentWas partially made possible by the results of a UK study published when the pandemic occurred. This has shown that for many patients the 1-week course is as effective as the 3-week course.

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 types of cancer, 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 UK in March and April 2020, national and international recommendations were soon issued to ensure the safe and effective use of radiotherapy. 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, University Academic Clinical Fellow at the University of Leeds and a clinical oncologist consultant 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 the NHS in the United Kingdom has seen rapid changes in the way radiation therapy is 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. “

Treatment during the first wave

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 radiotherapy 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. I am suffering from.

“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 surge in COVID-19, the NHS’s capabilities are under even greater stress, but the cancer team has leveraged all of last year’s clinical experience and innovations 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.

This study included contributions from the University of Oxford, the University of Verindle NHS Trust, the Norfolk & Norwich University Hospital NHS Foundation Trust, and NHS England.

Few patients present

Dr. Spencer of the University of Leeds Institute for Health Sciences and the Leeds CRUK Radiation Therapy Center of Excellence said: “When the country emerged from the first blockade in June, we found that the number of patients receiving radiation treatment was still declining. Until last year.

“The pandemic continues to cause serious confusion in cancer diagnosis and screening programs in some countries, which means fewer patients will be diagnosed with cancer during the first wave of the pandemic. This may have led to a persistent decline in the treatment we see. This is really worrisome as we know that patients diagnosed early with cancer are more likely to be cured. ..

“If people are concerned about their health, it is very important that they go and ask for help. Radiation services are up and ready to take care of people as usual. . ”