The Impact of the Acute Phase of COVID-19 on Radiotherapy Demand in South East Wales.

Madam — The coronavirus epidemic presents significant challenges to providing cancer care. Radiotherapy services need to depart from established pathways and protocols [1]. Here we summarise how COVID-19 has impacted local radiotherapy services.

On 23 March 2020, the Government announced a period of lockdown. We compared the subsequent 3 weeks with the same period in 2019.

Overall attendances to the radiotherapy department dropped by 28%. In the 2020 period, 74% of all attendances involved five tumour sites: breast (23%), urological (20%), head and neck (14%), colorectal (9%) and lung (8%). These figures were similar for 2019 except for urological sites (2019:29%) due to deferral of prostate radiotherapy +/- hormone treatment.

The biggest changes have occurred in the use of hypofractionated regimens. For breast cancer, there was an increase in the use of five-fraction regimens, with 48% of patients receiving 26 Gy in five fractions in 2020, up from 13% in 2019. This was supported by international consensus guidelines, together with the Fast-forward trial [2,3].

For head and neck patients, there was an increase in the 20-fraction regimen. These accounted for 18% patients in 2020, compared with 10% in 2019. Thirty-fraction regimens increased to 82% from 70%; 0% attended for a 35-fraction regimen (compared with 10% in 2019). The consensus advice is to consider hypofractionated regimens [4].

Short-course radiotherapy for rectal cancer has accounted for 75% of attendances in 2020 compared with 0% for 2019. International consensus guidelines advocate using short-course radiotherapy (25 Gy in five fractions) for patients traditionally treated with long-course chemoradiotherapy [5].

The coronavirus epidemic has undoubtedly led to significant changes in the treatment of patients resulting from changing referral patterns, treatment decision making and use of shorter fractionation schedules.

We are now planning for our recovery phase, while continuing to provide the safest care possible for our patients.

Conflicts of Interest

The authors declare no conflict of interest.