Dramatic changes were seen in the delivery of radiotherapy treatments for cancer during the first wave of the coronavirus pandemic in England.
Radiotherapy courses were delivered much shorter, treatments were delayed where it was safe to do so and some increases were seen to compensate for reduced surgical capacity.
Experts believe the changes reflect a dramatic shift in services from the NHS, and that the overall impact on cancer outcomes tends to be relatively small.
The new research, led by the University of Leeds, Public Health England and the Royal College of Radiologists, shows that radiotherapy treatment courses fell by 19.9% in April, 6.2% in May, and 11.6% in June 2020, compared to the same months the previous year.
These reductions equated to more than 3,000 fewer radiotherapy courses between 23 March and 28 June 2020, than expected *. However, it was likely that courses missed due to cancellation, where the risk of doing so, was low. In June, however, it is likely that the smaller number of courses could reflect a worrying fall in the number of cancer patients.
The new study is the first to assess the impact of pandemic disease on radiotherapy services in England and is published today in Oncology Lancet.
There was a rapid change in use for breast cancer treatments, partly enabled by published UK test results just as the pandemic struck, which showed that a one-week course was just as effective as a three-week course. for many patients * *.
Interestingly, the shortest course of treatment was used from just 0.2% of breast cancer radiotherapy courses in April 2019, up to 60.0% of all courses in April 2020.
The switch to shorter treatment courses has also been seen in other types of cancer, and will have helped keep patients safe and services running through the pandemic.
For some types of cancer there was a significant increase in the use of radiotherapy courses compared to the previous year. There was a 143.3% increase in therapeutic radiotherapy for bladder cancer and 71.3% for esophageal cancer in May, and 36.3% for bowel cancer in April.
These types of cancers are often treated with surgery. Radiotherapy offers an alternative therapeutic treatment or a way to safely delay, and these temporary enhancements appear to have been delivered to keep patients safe when surgery was not possible because of the pandemic.
Direction of radiotherapy during a pandemic
About one in three people with cancer in the UK will receive radiotherapy as part of their treatment ***. Radiotherapy can be used to treat patients with cancer, or to treat pain and other symptoms when medical treatment is not possible.
Treatments are often given using daily doses of radiotherapy over several weeks. Every cancer is different, and courses of radiotherapy differ depending on the type of cancer and the purpose of the treatment.
In March and April 2020, national and international recommendations were swiftly announced to ensure the safe and effective use of radiotherapy, as the first wave of COVID-19 hit the UK. The Royal College of Radiologists helped coordinate the writing and publication of many of these guides, with researchers from the University of Leeds contributing to many of these.
Lead author of the new study Dr Katie Spencer, University of Leeds University Academic Clinical Associate and Consultant Clinical Oncologist at Leeds Teaching Hospitals NHS Trust, said: “Radiotherapy is a very important treatment option for cancer, and our study shows that across the NHS England there was a rapid shift in the use of radiotherapy.
“It is remarkable to see that the data closely follows the guidelines published at the onset of the pandemic. For cancers such as breast and intestines, shorter and more intensive treatments have been delivered to achieve results. equal treatment of patients.
“Where treatment delays are safe, as in prostate cancer, delays have been used to reduce the risk of coronavirus outbreaks. This was particularly important for elderly patients, who are more vulnerable to the virus.
“In other cases, such as head and neck, and anal cancers, we found that the number of radiotherapy treatments hardly changed during the first wave. This was very encouraging, because we know that it is vital that delay these treatments. “
Treatment during the first wave
The researchers looked at the number of radiotherapy treatments taking place between February and June 2020 within NHS England, taken from the National Radiotherapy Dataset of Public Health England. They compared the number of radiotherapy courses, and their duration, with the same period in 2019, to look at the effects of pandemic coronavirus infection and lockout.
The largest decrease in treatment was seen for patients aged 70 and older (34.4% decrease in April 2020). This tends to be a concern where patient vulnerability to coronavirus risks was higher than the expected low risk of delayed treatment in some cases. For example, treatment for prostate cancer fell 77.0% in April 2020 compared to the previous year, while treatments for non-melanoma skin cancer fell 72.4% in the same month.
Co-author Dr Tom Roques, Medical Director, Professional Practice for Clinical Oncology at the Royal College of Radiologists, said: “This research demonstrates the incredible pace at which radiotherapy services within the NHS have been possible. change their treatment patterns to help protect patients with cancer, while addressing reduced surgical potential due to the global pandemic.
“Despite the pressures on the NHS, radiotherapy treatments were able to adapt effectively, finding alternative treatment options where possible, and continuing to meet standards. highest in the world of patient care.
“Among the current COVID-19 surge, the capacity of the NHS is under even greater strain. However, cancer teams are using all the clinical experience and innovations of last year to ensure that radiotherapy services continue to work and provide the best possible care for patients. “
The research team hopes their findings will help health care providers address the indirect effects of pandemic and the role of radiotherapy services in reducing those effects.
This research included donations from Oxford University, Velindre University NHS Trust, Norfolk & Norwich University Hospitals NHS Foundation Trust, and NHS England.
Fewer patients present
Dr Spencer, from Leeds University’s Institute of Health Sciences and Leeds CRUK’s Center for Radiotherapy Excellence, said: “As the country emerged from the first lock in June, we saw that the number of patients receiving radiotherapy continued to increase. the decrease compared to last year.
“The pandemic continues to cause significant disruption to cancer diagnosis and some national screening programs. This has resulted in fewer patients being diagnosed with cancer in the first wave of the pandemic and this appears to have led to a sustained decline in treatments we see. We know that patients who have been diagnosed with cancer early have a better chance of being treated so this is a major concern.
“If people are worried about their health it’s very important that they go for help. Radiotherapy services are still going on and ready to look after people, as they always have.”
###
Notes to editors
For interview requests please contact Leeds University press officer Ian Rosser on [email protected] or 07712 389448.
The paper, entitled ‘The impact of COVID-19 pandemic disease on radiotherapy services in England, UK: a population-based study from the National Radiotherapy Dataset’, is published in Oncology Lancet and will be available online once the embargo builds: follow this link: https: /
* As part of this study, the research team created a model to predict the number of radiotherapy courses expected in 2020. A comparison of the data itself with the model showed that there were 3,263 fewer radiotherapy courses on issued between 23 March and 28 June 2020 than expected. the pandemic did not occur.
** The changes to breast cancer radiotherapy treatments came after the publication of new guidelines and test results published in the UK just as the pandemic struck, which showed that a one-week course was just as effective as a three-course course weeks for many patients. The guide can be found on the Royal College of Radiologists website: https: /
*** One in three UK cancer patients receiving radiotherapy comes from data published by Borras et al. in 2015: https: /
University of Leeds
The University of Leeds is one of the largest institutions of higher education in the UK, with more than 38,000 students from more than 150 different countries, and a member of the Russell Group of research-intensive universities. The University plays an important role in the Turing, Rosalind Franklin and Royce Institutes.
We are one of the top ten universities for research power and influence in the UK, according to the 2014 Research Excellence Framework, and we are in the top 100 of QS World University Rankings 2021.
The University was awarded Gold by the Government’s Teaching Excellence Framework in 2017, recognizing the ‘highly sustainable’ teaching and learning provision. Twenty-six of our academics have won National Teaching Fellowships – more than any other institution in England, Northern Ireland and Wales – demonstrating the excellence of our teaching. http: // www.