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Changes in the management of patients having radical radiotherapy for lung cancer during the first wave of the COVID-19 pandemic in the UK

Changes in the management of patients having radical radiotherapy for lung cancer during the first wave of the COVID-19 pandemic in the UK
Changes in the management of patients having radical radiotherapy for lung cancer during the first wave of the COVID-19 pandemic in the UK

AIMS: in response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020.

MATERIALS AND METHODS: lung radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression.

RESULTS: in total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease.

CONCLUSIONS: the COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.

COVID-19, lung cancer, radiotherapy, reduced fractionation
0936-6555
19-27
Banfill, K.
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Croxford, W.
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Fornacon-Wood, I.
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Wicks, K.
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Ahmad, S.
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Britten, A.
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Carson, C.
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Dorey, N.
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Hatton, M
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Hiley, C.
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Thippu Jayaprakash, K.
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Jegannathen, A.
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Koh, P.
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Panakis, N.
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Peedell, C.
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Pope, A.
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Powell, C.
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Stilwell, C.
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Thomas, B.
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Toy, E.
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Wood, V.
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Yahya, S.
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Zhou, S.Y.
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Price, G.
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Faivre-Finn, C.
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Banfill, K.
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Croxford, W.
4030b719-12af-430e-beda-3c4510dc17c3
Fornacon-Wood, I.
c90357c0-b751-4e11-8848-227e2f48a3eb
Wicks, K.
ba826940-f991-4896-b0d4-76184e319515
Ahmad, S.
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Britten, A.
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Carson, C.
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Dorey, N.
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Hatton, M
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Hiley, C.
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Thippu Jayaprakash, K.
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Jegannathen, A.
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Koh, P.
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Panakis, N.
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Peedell, C.
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Pope, A.
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Powell, C.
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Stilwell, C.
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Thomas, B.
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Toy, E.
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Wood, V.
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Yahya, S.
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Zhou, S.Y.
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Price, G.
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Faivre-Finn, C.
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Banfill, K., Croxford, W., Fornacon-Wood, I., Wicks, K., Ahmad, S., Britten, A., Carson, C., Dorey, N., Hatton, M, Hiley, C., Thippu Jayaprakash, K., Jegannathen, A., Koh, P., Panakis, N., Peedell, C., Pope, A., Powell, C., Stilwell, C., Thomas, B., Toy, E., Wood, V., Yahya, S., Zhou, S.Y., Price, G. and Faivre-Finn, C. (2022) Changes in the management of patients having radical radiotherapy for lung cancer during the first wave of the COVID-19 pandemic in the UK. Clinical Oncology, 34 (1), 19-27. (doi:10.1016/j.clon.2021.10.009).

Record type: Article

Abstract

AIMS: in response to the COVID-19 pandemic, guidelines on reduced fractionation for patients treated with curative-intent radiotherapy were published, aimed at reducing the number of hospital attendances and potential exposure of vulnerable patients to minimise the risk of COVID-19 infection. We describe the changes that took place in the management of patients with stage I-III lung cancer from April to October 2020.

MATERIALS AND METHODS: lung radiotherapy during the COVID-19 Pandemic (COVID-RT Lung) is a prospective multicentre UK cohort study. The inclusion criteria were: patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between 2nd April and 2nd October 2020. Patients who had had a change in their management and those who continued with standard management were included. Data on demographics, COVID-19 diagnosis, diagnostic work-up, radiotherapy and systemic treatment were collected and reported as counts and percentages. Patient characteristics associated with a change in treatment were analysed using multivariable binary logistic regression.

RESULTS: in total, 1553 patients were included (median age 72 years, 49% female); 93 (12%) had a change to their diagnostic investigation and 528 (34%) had a change to their treatment from their centre's standard of care as a result of the COVID-19 pandemic. Age ≥70 years, male gender and stage III disease were associated with a change in treatment on multivariable analysis. Patients who had their treatment changed had a median of 15 fractions of radiotherapy compared with a median of 20 fractions in those who did not have their treatment changed. Low rates of COVID-19 infection were seen during or after radiotherapy, with only 21 patients (1.4%) developing the disease.

CONCLUSIONS: the COVID-19 pandemic resulted in changes to patient treatment in line with national recommendations. The main change was an increase in hypofractionation. Further work is ongoing to analyse the impact of these changes on patient outcomes.

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e-pub ahead of print date: 28 October 2021
Published date: 1 January 2022
Additional Information: This work was supported by Cancer Research UK RadNetManchester (grant number C1994/A28701) and NIHR Manchester Biomedical Research Centre (grant numberBRC-1215-20007).
Keywords: COVID-19, lung cancer, radiotherapy, reduced fractionation

Identifiers

Local EPrints ID: 453650
URI: http://eprints.soton.ac.uk/id/eprint/453650
ISSN: 0936-6555
PURE UUID: 22307497-698e-406d-b627-46274caae2df

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Date deposited: 20 Jan 2022 17:43
Last modified: 30 Jun 2022 17:34

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Contributors

Author: K. Banfill
Author: W. Croxford
Author: I. Fornacon-Wood
Author: K. Wicks
Author: S. Ahmad
Author: A. Britten
Author: C. Carson
Author: N. Dorey
Author: M Hatton
Author: C. Hiley
Author: K. Thippu Jayaprakash
Author: A. Jegannathen
Author: P. Koh
Author: N. Panakis
Author: C. Peedell
Author: A. Pope
Author: C. Powell
Author: C. Stilwell
Author: B. Thomas
Author: E. Toy
Author: V. Wood
Author: S. Yahya
Author: S.Y. Zhou
Author: G. Price
Author: C. Faivre-Finn

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