The study from the University of Leeds by Public Health England and the Royal College of Radiologists assessed how the use of radiation therapy changed in a number of ways in the first wave of the revolution.
Dr. Katie Spencer, PhD. Image courtesy of Leeds University.
Compared to the same periods in 2019, in 2020 the number of radiotherapy courses fell 19.9% in April, 6.2% in May, and 11.6% in June, reported Dr. Katie Spencer, PhD, oncologist at Leeds Teaching Hospitals NHS Trust, and colleagues. The data highlight guidelines during the epidemic and more appropriate course of radiation therapy in some key areas, such as short courses with high doses (hypofractionated) where appropriate, delays for non-surgical care, and increased use. of radiation therapy as an alternative to surgery.
“Although the activity of radiotherapy decreased during the first wave of the pandemic, our data suggest that the overall impact of this decline tends to be moderate,” wrote Spencer et al. “Furthermore, radiotherapy appears to have mitigated against some of the indirect harms of the pandemic by maintaining therapeutic treatment options despite the challenges facing services. surgery. “
The study was designed to assess the impact of COVID-19 pandemic disease on radiotherapy services across the National Health Service (NHS) in England and provided guidance in response to the revolution. About a third of cancer patients usually receive radiation therapy.
“Along with anticancer surgery and systemic therapy, radiotherapy plays a major role both as a therapeutic treatment and in palliative care. [localized] symptoms from a progressive disease, “the authors wrote.” At the outset of the pandemic, all three treatments were affected by restrictions on the COVID-19 test and staff shortages. “
Researchers evaluated the use of radiation therapy delivered by the 52 NHS radiation treatment providers in pre-pandemic and late June 2020. During the lock-in period – from 23 March to 28 June – the total number of treatment courses fell radiation by 3,263 across the NHS in England, while the number of treatment posts was down 119,050, the authors said.
The declines were in line with national and international guidelines for patient prioritization / testing and care management during the pandemic.
“The larger fall in treatment attendance largely reflects a rapid increase in the use of ultra-hypofractionated treatment regimens over a number of years. [tumor] sites, “the authors noted.
For example, in April 2020, researchers reported significantly greater use of a treatment regimen that specified 26 Gy in five fractions for neoadjuvant treatment of breast cancer, compared to the 40 Gy in 15 fractions that were more common before -pandemic.
“There has been a significant increase in the use of ultra-hypofractionation in neoadjuvant treatment of rectal cancer, with a decrease in the use of less than 2 Gy per fractional rule,” they wrote.
Researchers also said that compared to other age groups, they found a greater decline in treatment for people older than 70, who may present a higher risk to patients due to age and comorbidities, as well as the ability to defer care for some. conditions such as prostate cancer and nonmelanoma skin cancer.
In types of tumors that typically require more rapid treatment, such as cancers of the rectum, bladder, and esophagus, the researchers saw an increase in the number of treatment courses. Spencer and colleagues suggested that this may indicate the use of radiation therapy as an alternative to surgery. For example, the number of treatment courses for bladder cancer rose 143.3% in May 2020 compared to May 2019.
Areas of concern, however, include a decline in the number of palliative treatment courses and a continuing decline in radiation treatment in June 2020 compared to June 2019. NHS data show that the number of reports for typical cancer are 21% lower in June 2020 compared to the same period in 2019, the authors noted.
“New studies were excluded by 26%, which may contribute significantly to the continued inhibition in radiotherapy activity up to June 2020,” wrote Spencer et al.
Outcomes may be affected by this trend as the data is tracked over time.
“As COVID-19 cases recur, these data are crucial for shaping indirect damage to the pandemic and establishing a new baseline for radiotherapy treatments from which planning for continued delivery of care across subsequent pandemic waves and into the recovery beyond, “authors wrote.” They also emphasize the need to address any ongoing delays in cancer diagnosis pathways. . “
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