Session Item

The COVID-19 pandemic forced radiotherapy (RT) services to implement changes based on local rates of COVID-19, scale of service disruption and rapidly drawn-up guidelines. Whilst a fall in RT activity has been documented (1), the decisions underpinning this change have not been reported. COVID-RT is a National Cancer Research Institute (NCRI) initiative to understand why changes in treatment schedules were implemented during the pandemic, and to explore their impact on patient outcomes.

All UK RT centres were invited to participate; sites completed a spreadsheet capturing information on adult cancer patients considered for radical RT from 1/03/2020 to 30/09/2020; data collection continued for some cancers until 28/02/2021. Following ethical approval, local data was de-identified and collated centrally in Cancer Research UK’s Trusted Research Environment.

Data for 17,283 adult patients from 26 centres in England (15,996) and 1 in Northern Ireland (NI) (1,287) are presented. Treatment intent was reported as unchanged in 97% of patients; only 0.3% of patients received palliative instead of radical RT. Treatment was altered in 38% of patients. The most frequent changes were:

•    Altered RT fractionation, primarily hypofractionation, occurred in 23% of patients in England and 31% in NI. In England 79% of hypofractionated treatments were for breast cancer.

•    Altered RT timing occurred in 8.7% of patients in England and 33% in NI, most commonly RT deferral by clinical decision. In England 72% of deferred patients had prostate cancer. RT was omitted in 0.8% of patients in England and 2.8% in NI, as a result of either clinical decision (England 0.5%; NI 1.5%) or patient choice (England 0.3%; NI 1.3%).

•    Altered concurrent chemotherapy occurred in 24% of patients in England and 32% in NI. It was most commonly omitted in rectal cancer (26% of patients with omitted concurrent chemotherapy in England; 62% in NI) and head & neck cancer (22%).

•    Altered RT indication occurred in 2.3% of patients in England, with RT given as a replacement for, or a bridge to, surgery. RT mainly replaced surgery in oesophago-gastric (46% of those with RT replacing surgery) and bladder cancer (16%), while 64% of those receiving RT as a bridge to surgery had rectal cancer. In NI, 1.8% of RT courses bridged to, or replaced, surgery, most commonly for oesophago-gastric, soft tissue & bone cancer.

Figure 1 shows treatment changes over time; Figure 2 shows variation between cancer types.

Fig 1:

Fig 2:

Whilst significant alterations in radiotherapy timing, fractionation and concurrent chemotherapy regimens occurred during the pandemic, the majority of patients still received radical treatment, with just 0.3% of patients switched to palliative treatment as a direct consequence of COVID. Data from Scotland and Wales are awaited, and planned linkage to survival data will determine the impact of these changes on patient outcomes.



(1) K Spencer et al, Lancet Oncol 2021;22:309-20