The direct health and socio-economic consequences of covid19 are now well known. Nevertheless, with 10 million deaths a year according to the WHO, cancer is the second leading cause of death worldwide, and the indirect impact of the epidemic on cancer management has yet to be quantified.
Containment measures and the saturation of hospital wards had a major impact on diagnosis, care and treatment times for cancer patients, while surgical activity decreased to make room for covid19 patients, encouraging the use of radiotherapy as a treatment option, with often short sessions and minimal physical contact with the patient.
Right from the start of the epidemic, groups of international experts issued recommendations on treatment management, depending on the type of cancer and the therapeutic strategy envisaged. This note provides a brief overview of the impact of covid19 on radiotherapy departments and the measures taken to maintain their activity during this unprecedented health crisis.
We’ll be focusing on the most common cancers, for which there are more data in the literature: breast, prostate, ENT and lung cancers. As the literature on this subject is more extensive in Europe and North America, the data presented in this document will mainly concern these geographical areas.
In April 2020, at a time when a state of health emergency had just been declared in most European and North American countries, ESTRO and ASTRO joined forces to issue recommendations for the treatment of certain cancers1,2.
Two scenarios are taken into account in these recommendations: early (significant alteration in the benefit-risk balance due to potential covid19 contamination during treatment) and late (significant reduction in radiotherapy resources). These recommendations clarify when treatments should be prioritized, modified, postponed or cancelled, depending on the patient’s overall condition (covid19-positive patient, risk of cancer progression, chances of successful treatment, etc.) and the treatment strategy envisaged in the first place.
Among these recommendations, it is advisable to interrupt or postpone treatment in the case of a covid 19-positive patient, whatever the grade of cancer. Another example: hypofractionation (reducing the number of sessions by increasing the dose delivered at each session) should be considered as soon as possible as an alternative to normal fractionation, except in the case of concomitant chemotherapy.
1. Guckenberger M, Belka C, Bezjak A, et al. Practice recommendations for lung cancer radiotherapy during the COVID-19 pandemic: An ESTRO-ASTRO consensus statement. Radiotherapy and Oncology. 2020;146:223-229. doi:10.1016/j.radonc.2020.04.001
2. Thomson DJ, Palma D, Guckenberger M, et al. Practice Recommendations for Risk-Adapted Head and Neck Cancer Radiation Therapy During the COVID-19 Pandemic: An ASTRO-ESTRO Consensus Statement. International Journal of Radiation Oncology Biology Physics. 2020;107(4):618-627. doi:10.1016/j.ijrobp.2020.04.016
3. Gasparri ML, Gentilini OD, Lueftner D, Kuehn T, Kaidar-Person O, Poortmans P. Changes in breast cancer management during the Corona Virus Disease 19 pandemic: An international survey of the European Breast Cancer Research Association of Surgical Trialists (EUBREAST). Breast. 2020;52:110-115. doi:10.1016/j.breast.2020.05.006
4. Beer KT, Betz M, Breuneval T, et al. A national survey on radiation oncology patterns of practice inSwitzerland during the COVID-19 pandemic: Present changes and futureperspectives. 2020;(January).
5. Spencer K, Jones CM, Girdler R, et al. The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study. The Lancet Oncology. 2021;22(3):309-320. doi:10.1016/s1470-2045(20)30743-9
6. Slotman BJ, Lievens Y, Poortmans P, et al. Effect of COVID-19 pandemic on practice in European radiation oncology centers. Radiotherapy and Oncology. 2020;150:40-42. doi:10.1016/j.radonc.2020.06.007
7. Roberge D, Delouya G, Bohigas A, Michalowski S. Catching the wave: Quantifying the impact of COVID on radiotherapy delivery. Current Oncology. 2021;28(1):152-158. doi:10.3390/curroncol28010018
8. Wakefield D v., Sanders T, Wilson E, et al. Initial Impact and Operational Responses to the COVID-19 Pandemic by American Radiation Oncology Practices. International Journal of Radiation Oncology Biology Physics. 2020;108(2):356-361. doi:10.1016/j.ijrobp.2020.06.060
9. Michael Amdi Madsen I. World Cancer Day: The impact of COVID-19 on cancer control. Accessed May 20, 2021. https://www.iaea.org/fr/newscenter/news/journee-mondiale-du-cancer-lincidence-de-la-covid-19-sur-la-lutte-contre-le-cancer
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