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Person undergoing radiography imaging.

NDPH researcher, Professor Eva Morris has contributed to a new study which reveals that the COVID-19 pandemic led to striking changes to radiotherapy treatments in England. These reflect an impressive effort to keep patients safe while they access life-saving treatment.

A new study, published today in The Lancet Oncology, has assessed for the first time the impact of the COVID-19 pandemic on radiotherapy services in England. The results indicate that the NHS rapidly adjusted to keep patients as safe as possible, yet fewer patients may be coming forward to be diagnosed.

The research team, led by the University of Leeds, looked at the number of radiotherapy treatments taking place between February and June 2020 within the English NHS, taken from Public Health England’s National Radiotherapy Dataset. They compared the number of radiotherapy courses, and their length, with the same time period in 2019, to assess the effects of the coronavirus pandemic and lockdown.

The results indicate significant change within radiotherapy services, with much shorter treatments being delivered, treatments being delayed where safe to do so, and increases in some treatments to compensate for reduced surgical capacity. The researchers 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.

During the first COVID-19 lockdown, the number of radiotherapy treatments carried out decreased dramatically. The number of treatments carried out reduced by 19.9% in April, 6.2% in May, and 11.6% in June 2020, compared with the same months the previous year. This equates to over 3,000 fewer courses of radiotherapy between 23 March and 28 June 2020, than would have been expected. The largest reduction in treatments was seen for patients aged 70 and above (34.4% reduction in April 2020).

Initially, these missed courses were likely to be due to postponement, where the risk of doing so was deemed low. By June, however, the reduced number of courses may reflect a worrying fall in the number of patients being diagnosed with cancer.

Treatment for breast cancer in particular saw a significant change, enabled in part by the results of a UK trial published just as the pandemic struck. This showed that a one-week course of radiotherapy was 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 minimise potential exposure to coronavirus for vulnerable patients.

For some cancer types there was a significant increase in the use of radiotherapy courses compared to the previous year. Curative radiotherapy increased by 143.3% 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, but radiotherapy can offer an alternative curative treatment or a means to safely delay, when surgery is not possible.

The changes reflect new national and international recommendations in radiotherapy use that were quickly published in March and April 2020, as the first wave of COVID-19 hit the UK.

The research team hope their findings will help healthcare providers to understand the indirect consequences of the pandemic and the role of radiotherapy services in minimising those effects.

Besides NDPH, this research involved contributions from Velindre University NHS Trust, Norfolk & Norwich University Hospitals NHS Foundation Trust, and NHS England.