Dramatic changes were seen in the delivery of radiotherapy treatments for cancer during the first wave of the coronavirus pandemic in England.
Much shorter radiotherapy courses were delivered, treatments were delayed where it was safe to do so and some increases were seen in order to compensate for reduced surgical capacity.
Experts believe the changes reflect an impressive adaption of services by the NHS, and that the overall impact on cancer outcomes is likely to be modest.
The new research, led by the University of Leeds, with Public Health England and the Royal College of Radiologists, reveals that there was a decrease in radiotherapy treatment courses of 19.9% in April, 6.2% in May, and 11.6% in June 2020, compared with the same months the previous year.
These decreases equated to more than 3,000 fewer courses of radiotherapy between 23 March and 28 June 2020, than would have been expected*. However, the missed courses were likely to be due to postponement, where the risk of doing so was deemed low. In June though, it appears that the reduced number of courses may reflect a worrying fall in the number of patients being diagnosed with cancer.
The new study is the first to assess the impact of the pandemic on radiotherapy services in England and is published today in The Lancet Oncology.
A rapid change in practice occurred for breast cancer treatments, enabled in part by the results of a UK trial published just as the pandemic struck, which showed a one-week course to be just as effective as a three-week course for many patients**.
Strikingly, the use of the shorter course of treatment went from just 0.2% of all breast cancer radiotherapy courses in April 2019, up to 60.0% of all courses in April 2020.
The switch to shorter courses of treatment was also seen in other types of cancer, and will have helped to keep patients safe and services running during the pandemic.
For some cancer types there was a significant increase in the use of radiotherapy courses compared to the previous year. There was an increase of 143.3% in curative radiotherapy for bladder cancer and 71.3% for oesophageal cancer in May, and 36.3% for bowel cancer in April.
These types of cancer are often treated with surgery. Radiotherapy offers an alternative curative treatment or means to safely delay, and it is likely these timely increases were delivered to keep patients safe when surgery was not possible due to the pandemic.
Radiotherapy guidance during pandemic
Around one in three people with cancer in the UK will receive radiotherapy as part of their treatment***. Radiotherapy can be used to try and cure a patient of their cancer, or to treat pain and other symptoms when curative treatment is not possible.
