medwireNews: The total number of radiotherapy courses delivered in England fell significantly during the first peak of the COVID-19 pandemic but this was accompanied by a rapid increase in the use of hypofractionated regimens, study data show.
Writing in The Lancet Oncology, Katie Spencer (University of Leeds, UK) and colleagues say the decline was “predominantly attributable to a reduction in treatments for prostate and non-melanoma skin cancer – malignancies for which there is evidence for the safety of treatment delay.”
They add: “By contrast, treatments for oesophageal, bladder, and rectal cancers markedly increased.”
The findings are based on data from the English National Radiotherapy Dataset recorded between February 2019 and June 2020.
The researchers found that the mean weekly number of radiotherapy courses delivered in April 2020 was 19.9% lower than the figure for the same period in 2019. For May and June, the numbers were 6.2% and 11.6% lower, respectively, in 2020 relative to 2019.
Even greater reductions occurred for the total number of treatment attendances, at 29.1%, 31.4%, and 31.5% in April, May, and June 2020, respectively, compared with the corresponding months in 2019.
In terms of real numbers, Spencer and team estimate that 3263 fewer treatment courses and 119,050 fewer attendances were delivered in England between 23 March and 28 June 2020 than would have been expected if the pandemic not occurred.
The authors note that “[t]he disproportionately greater fall in treatment attendances largely reflects a rapid increase in the use of ultra-hypofractionated treatment regimens across several tumour sites.”
Indeed, ultra-hypofractionation (≥5 Gy per fraction) treatment increased from 9.4% of mean weekly courses in April 2020 to 39.9%, 40.0%, and 34.0% of those in April, May, and June 2020, respectively.
The increase was largely due to a significant increase in the use of 26 Gy in five fractions for adjuvant breast cancer treatment, with rates going from 0.2% of mean weekly courses in April 2019 to 60.6% in April 2020.
Spencer and team also found differences by cancer type, with the largest treatment course reductions from 2019 to 2020 occurring among people with prostate cancer (77.0% in April) and non-melanoma skin cancer (72.4% in April).
By contrast, there were a 64.2%, 41.2%, and 36.3% increases in radiotherapy courses for bladder, esophageal, and rectal cancer, respectively, in April 2020, compared with April 2019.
Spencer and co-authors say: “Overall, the effect on cancer outcomes of changes in radiotherapy activity during the first pandemic peak is likely to be modest, and an increase in radiotherapy use might have helped to mitigate against the loss of surgical capacity.
“However, the continued suppression in radiotherapy activity up to June, 2020, supports an urgent need to restore diagnostic pathways.”
The researchers add: “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.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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Lancet Oncol 2021; doi:10.1016/ S1470-2045(20)30743-9