The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study

Abstract

Background The indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have been affected is unclear. We aimed to assess the impact of the pandemic on radiotherapy activity in England. MethodsIn this population-based study, data relating to all radiotherapy delivered for cancer in the English NHS, between Feb 4, 2019, and June 28, 2020, were extracted from the National Radiotherapy Dataset. Changes in mean weekly radiotherapy courses, attendances (reflecting fractions), and fractionation patterns following the start of the UK lockdown were compared with corresponding months in 2019 overall, for specific diagnoses, and across age groups. The significance of changes in radiotherapy activity during lockdown was examined using interrupted time-series (ITS) analysis. FindingsIn 2020, mean weekly radiotherapy courses fell by 19•9% in April, 6•2% in May, and 11•6% in June compared with corresponding months in 2019. A relatively greater fall was observed for attendances (29•1% in April, 31•4% in May, and 31•5% in June). These changes were significant on ITS analysis (p<0•0001). A greater reduction in treatment courses between 2019 and 2020 was seen for patients aged 70 years or older compared with those aged younger than 70 years (34•4% vs 7•3% in April). By diagnosis, the largest reduction from 2019 to 2020 in treatment courses was for prostate cancer (77•0% in April) and non-melanoma skin cancer (72•4% in April). Conversely, radiotherapy courses in April, 2020, compared with April, 2019, increased by 41•2% in oesophageal cancer, 64•2% in bladder cancer, and 36•3% in rectal cancer. Increased use of ultra-hypofractionated (26 Gy in five fractions) breast radiotherapy as a percentage of all courses (0•2% in April, 2019, to 60•6% in April, 2020; ITS p<0•0001) contributed to the substantial reduction in attendances.Interpretation Radiotherapy activity fell significantly, but use of hypofractionated regimens rapidly increased in the English NHS during the first peak of the COVID-19 pandemic. An increase in treatments for some cancers suggests that radiotherapy compensated for reduced surgical activity. These data will assist health-care providers in understanding the indirect consequences of the pandemic and the role of radiotherapy services in minimising these consequences.

Breast Cancer Management During the COVID-19 Pandemic: The Senologic International Society Survey

“…Hypofractionated regimens were preferred for BC treatment, whereas in other cases, treatment was discontinued. Spencer et al (12) published a report on radiotherapy modifications in the United Kingdom during the pandemic and found similar results. For instance, treatment with ultrahypofractionated regimens (26 Gy in 5 fractions) greatly increased from 0.2% in April 2019 to 60.6% in April 2020.…”

Professional practice changes in radiotherapy physics during the COVID-19 pandemic

“…The increase was markedly more common in centres with large patient numbers and it has been proposed extensively to reduce the patient presence in the hospital [12] . However, hypofractionation use is country-dependent [17] , [25] and for centres not yet applying it, implementation represents significant work, not easy to carry out under pressure [12] . Concerns around its level of evidence have also been raised which may have prevented wider implementation [12] , [20] .…”

“…A web-based questionnaire (Supplementary material A.I) was distributed to ESTRO's physics members via e-mail (2500 recipients) and the broader medical physics community via social media. It contained 39 questions on demographics (questions 1-12), department organisation (13)(14)(15)(16)(17)(18)(19)(20), changes in practice (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), morale and mental health (32)(33) and expected future impacts (34)(35)(36)(37)(38), with an open textbox for further comment(s). Responses were collected anonymously from June 18 to September 24, 2020.…”

“…RT postponement when clinically supported, or hypofractionation) and to limit interaction between team-members (e.g. shift work) [2] , [5] , [6] , [7] , [8] , [9] , [10] , [16] , [17] , [18] . These were considered a “contingency standard of care” in an “early pandemic scenario” while more drastic resource shortages and patient triage were anticipated in a “second (later) pandemic scenario” [19] , [20] .…”

Telehealth in Multidisciplinary Target Delineation for Radiotherapy During the COVID-19 Pandemic. A Review and a Case

“…Furthermore, the patients are at a greater risk of serious complications from a COVID-19 infection, largely due to comorbidities ( 1 ), and recent treatment may be a risk factor for a severe course of COVID-19 ( 2 , 3 ). Due to staffing challenges and risk of disease transmissions, radiotherapy treatments have been postponed, interrupted, shortened using hypo-fractionation or even cancelled ( [4] , [5] , [6] , [7] , [8] , [9] ). The impact of the pandemic, of course, depending on the regional effect of the pandemic.…”