COVID-19-Related Changes To Radiotherapy Use Characterised

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: A nationwide study has detailed how use of radiotherapy changed in the English National Health Service during the initial months of the COVID-19 pandemic.  

“Although radiotherapy activity decreased during the first wave of the pandemic, our data suggest that the overall impact of this decline is likely to be modest”, say Katie Spencer, from the University of Leeds in the UK, and co-authors in The Lancet Oncology. 

“In addition, radiotherapy appears to have mitigated against some of the indirect harms of the pandemic by maintaining curative treatment options despite the challenges facing surgical services.” 

The team’s analysis of the National Radiotherapy Dataset showed a decrease from 2019 to 2020 in the average number of weekly radiotherapy courses in April (19.9%), May (6.2%) and June (11.6%), as well as greater reductions in patient attendance over these months (29.1%, 31.4% and 31.5%, respectively). 

These decreases were all statistically significant when assessed using an interrupted time-series analysis, the researchers say. 

Prostate cancer and non-melanoma skin cancer patients had the biggest reductions in the average use of weekly curative radiotherapy, with decreases in April 2020 of 77.0% and 72.4%, respectively, compared with April 2019. 

But April 2020 also saw increases in the use of radiotherapy for the treatment of bladder, oesophageal and rectal cancers, of 64.2%, 41.2% and 36.3%, respectively, “which might reflect the use of radiotherapy as an alternative definitive treatment approach to surgery”, write Katie Spencer and co-investigators. 

Use of radiotherapy fell by a greater extent in patients aged at least 70 years versus younger patients, with a decrease in the mean number of weekly courses between April 2019 and April 2020 of 34.4% versus 7.3%. 

The biggest discrepancies in changes in radiotherapy use between patients aged at least 70 years versus younger patients occurred in breast cancer (–32.5 vs 0.3%) and non-melanoma skin cancer (–71.0 vs –52.9%). 

“This might partly be a consequence of decisions made by clinicians and patients to defer treatment in this higher-risk group”, the researchers remark. For example, prostate cancer evidence supports consideration of active surveillance or a delay in radiotherapy for up to 6 months with the use of androgen deprivation therapy, they postulate. 

While use of weekly mild-to-moderately hypofractionated radiotherapy, given in 2.5–4.9 Gy/fraction, decreased in spring 2020, use of ultra-hypofractionated radiation, defined as doses of at least 5.0 Gy/fraction, increased by 34.0–40.0% between April and June 2020. 

In particular, breast cancer patients were significantly more likely to receive an ultra-hypofractionated adjuvant radiotherapy course of 26 Gy over five fractions in April 2020 than in April 2019, at an average of 60.6% versus 0.2% of weekly courses, while use of 40 Gy over 15 fractions in this patient group fell from an average 91.5% to 33.0% of courses.  

There were also changes in the use of palliative radiotherapy, with an increase in the use of a single fraction, from an average 39.3% to 50.0% of weekly courses from April 2019 to April 2020, but a decrease in the use of more than five fractions, from 22.0% to 16.0% of treatments. 

“As COVID-19 cases again rise, these data are crucial for modelling indirect harms of the pandemic and establish a new baseline for radiotherapy treatments from which to plan for the ongoing delivery of care throughout subsequent pandemic waves and into the recovery beyond”, the researchers conclude. 

“They also reinforce the need to address any persisting delays in cancer diagnostic pathways.” 

Reference 

Spencer K, Jones CM, Girdler R, et al. The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. Lancet Oncol; Advance online publication 22 January 2021. DOI: https://doi.org/10.1016/S1470-2045(20)30743-9