Faculty of Medicine and Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Faculty of Medicine and Health, University of Leeds, Leeds, UK; Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Lancet Oncol. 2021 Mar;22(3):309-320. doi: 10.1016/S1470-2045(20)30743-9. Epub 2021 Jan 22.
The indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have been affected is unclear. We aimed to assess the impact of the pandemic on radiotherapy activity in England.
In this population-based study, data relating to all radiotherapy delivered for cancer in the English NHS, between Feb 4, 2019, and June 28, 2020, were extracted from the National Radiotherapy Dataset. Changes in mean weekly radiotherapy courses, attendances (reflecting fractions), and fractionation patterns following the start of the UK lockdown were compared with corresponding months in 2019 overall, for specific diagnoses, and across age groups. The significance of changes in radiotherapy activity during lockdown was examined using interrupted time-series (ITS) analysis.
In 2020, mean weekly radiotherapy courses fell by 19·9% in April, 6·2% in May, and 11·6% in June compared with corresponding months in 2019. A relatively greater fall was observed for attendances (29·1% in April, 31·4% in May, and 31·5% in June). These changes were significant on ITS analysis (p<0·0001). A greater reduction in treatment courses between 2019 and 2020 was seen for patients aged 70 years or older compared with those aged younger than 70 years (34·4% vs 7·3% in April). By diagnosis, the largest reduction from 2019 to 2020 in treatment courses was for prostate cancer (77·0% in April) and non-melanoma skin cancer (72·4% in April). Conversely, radiotherapy courses in April, 2020, compared with April, 2019, increased by 41·2% in oesophageal cancer, 64·2% in bladder cancer, and 36·3% in rectal cancer. Increased use of ultra-hypofractionated (26 Gy in five fractions) breast radiotherapy as a percentage of all courses (0·2% in April, 2019, to 60·6% in April, 2020; ITS p<0·0001) contributed to the substantial reduction in attendances.
Radiotherapy activity fell significantly, but use of hypofractionated regimens rapidly increased in the English NHS during the first peak of the COVID-19 pandemic. An increase in treatments for some cancers suggests that radiotherapy compensated for reduced surgical activity. These data will assist health-care providers in understanding the indirect consequences of the pandemic and the role of radiotherapy services in minimising these consequences.
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COVID-19 大流行对癌症结局的间接影响日益受到关注。然而，关键治疗方式受到影响的程度尚不清楚。我们旨在评估大流行对英国放射治疗活动的影响。
在这项基于人群的研究中，从国家放射治疗数据库中提取了 2019 年 2 月 4 日至 2020 年 6 月 28 日期间英国国民保健署（NHS）提供的所有癌症放射治疗的数据。与 2019 年同期相比，在英国封锁开始后，观察每周放射治疗课程、就诊次数（反映分次剂量）和分割模式的变化，以及特定诊断和各年龄段的变化。使用中断时间序列（ITS）分析来检查放射治疗活动在封锁期间的变化是否具有统计学意义。
2020 年 4 月、5 月和 6 月每周放射治疗课程分别下降 19.9%、6.2%和 11.6%，与 2019 年同期相比。就诊次数的下降幅度更大（4 月为 29.1%，5 月为 31.4%，6 月为 31.5%）。ITS 分析显示这些变化具有统计学意义（p<0.0001）。与 70 岁以下患者相比，70 岁或以上患者的治疗课程在 2019 年至 2020 年之间的降幅更大（4 月分别为 34.4%和 7.3%）。按诊断分类，前列腺癌（4 月为 77.0%）和非黑色素瘤皮肤癌（4 月为 72.4%）的治疗课程降幅最大。相反，2020 年 4 月与 2019 年 4 月相比，放射治疗课程在食管癌中增加了 41.2%，膀胱癌增加了 64.2%，直肠癌增加了 36.3%。英国国民保健署中，超分割（5 次分割 26Gy）乳腺癌放疗的使用比例（2019 年 4 月为 0.2%，2020 年 4 月为 60.6%；ITS p<0.0001）显著增加，这导致就诊次数大幅减少。
在 COVID-19 大流行的第一个高峰期间，英国 NHS 的放射治疗活动显著下降，但超分割方案的应用迅速增加。一些癌症治疗的增加表明，放射治疗弥补了手术活动的减少。这些数据将有助于医疗保健提供者了解大流行的间接后果，以及放射治疗服务在最大限度减少这些后果方面的作用。
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