In a population-based study reported in The Lancet Oncology, Spencer et al found that mean weekly radiotherapy courses for cancer and attendance for receipt of fractions declined significantly during the first peak of the COVID-19 pandemic in England. However, use of hypofractionated radiotherapy rapidly increased in the same time period.
The study involved National Radiotherapy Dataset data on all radiotherapy delivered for cancer in the English NHS between February 4, 2019, and June 28, 2020. Mean weekly radiotherapy courses, attendances for receipt of radiotherapy fractions, and fractionation patterns after the start of the United Kingdom lockdown on March 23 through June 28, 2020, were compared with those during April, May, and June of 2019. Significance of changes in radiotherapy activity was assessed using interrupted time-series analysis.
“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 minimizing these consequences.”— Spencer et al
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Mean weekly radiotherapy courses decreased by 19.9% in April 2020, 6.2% in May 2020, and 11.6% in June 2020 vs the corresponding months in 2019 (P < .0001). Across radiotherapy providers, changes ranged from –53.5% to +13.3% in April, –45.7% to +15.4% in May, and –28.7% to +31.9% in June.
Attendances declined by 29.1% in April, 31.4% in May, and 31.5% in June (P < .0001).
A greater reduction in treatment courses was observed among patients aged ≥ 70 years vs < 70 years in April (34.4% vs 7.3%), with the difference largely reflecting reductions for breast cancer (32.5% vs +0.3%) and nonmelanoma skin cancer (71.0% vs 52.9%).
Katie Spencer, PhD
According to diagnosis, the largest reductions in treatment courses were observed for prostate cancer in April (77.0%) and nonmelanoma skin cancer in April (72.4%). Increases in treatment courses in April were observed for esophageal cancer (41.2%), bladder cancer (64.2%), and rectal cancer (36.3%).
Among all patients, mean weekly use of mild to moderately hypofractionated radiotherapy regimens (2.5–4.9 Gy per fraction) as a proportion of all radiotherapy courses decreased in April from 60.9% to 38.9%, and remained at lower levels in May (39.9%) and June (43.4%). Use of ultrahypofractionation (≥ 5 Gy per fraction) increased from 9.4% to 39.9% in April and remained at higher levels in May (40.0%) and June (34.0%). A large increase in use of ultrahypofractionated radiotherapy was observed in April for breast cancer (0.2% vs 60.6%, P < .0001). Increased use of hypofractionated radiotherapy contributed to the reduction in attendances.
The investigators concluded, “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 minimizing these consequences.”
Katie Spencer, PhD, of the Faculty of Medicine and Health, University of Leeds, is the corresponding author for The Lancet Oncology article.
Disclosure: The investigators reported that there was no external funding for the study. For full disclosures of the study authors, visit thelancet.com.