The Impact of COVID-19 on Radiotherapy Services in Scotland, UK: A Population-based Study.

AIMS: The effect of the COVID-19 pandemic on cancer radiotherapy services is largely unknown. The aim of the present study was to investigate the impact of the resultant contingency plans on radiotherapy cancer services in Scotland. MATERIALS AND METHODS: Detailed data of radiotherapy activity at our centre were collected from 1 April 2019 to 31 March 2021. Differences in mean weekly radiotherapy courses, dose and fractionation patterns and treatment intent were compared with corresponding pre-pandemic months for all treatment sites. Qualitative data were collected for a subgroup of radical radiotherapy patients. RESULTS: Total radiotherapy courses decreased from 6968 to 6240 (-10%) compared with the previous year, prior to the pandemic. Average weekly radiotherapy courses delivered were 134 (standard deviation ±13), decreasing by 10% to 120 (standard deviation 15) (Welch's t-test, P < 0.001). The greatest decrease in new start treatment courses was observed from May to August 2020 (-7.7%, -24.0%, -16.7% and -18.7%) compared with the corresponding months in 2019. A significant reduction was seen for female patients <70 years (-16%) compared with females >70 years (-8%) or their male counterparts (-7% and -6%, respectively). By diagnosis, the largest reductions between pre- and post-pandemic levels were for anal (-26%), breast (-18%) and prostate (-14%) cancer. Contrarily, a significant increase was found for bladder (28%) and oesophageal (11%) cancers. CONCLUSIONS: Over the first 12 months of the COVID-19 pandemic, radiotherapy activity significantly decreased compared with the 12 months prior. Due to issued guidance, the use of hypofractionated regimens increased, contributing to the reduction in treatments for some tumour sites. An increase in other tumour sites can probably be attributed to the reduction or cancellation of surgical interventions. These results will inform our understanding of the indirect consequences of the pandemic on radiotherapy services.

An update on the STRATIFY (staging by thoracoscopy in potentially radically treatable non-small cell lung cancer associated with minimal pleural effusion) study

IntroductionPleural effusion is common in lung cancer. Metastatic disease may be confirmed on imaging or fluid sampling. A minority of patients however with otherwise radically treatable disease have a small effusion not amenable to aspiration, or from which fluid cytology is negative;termed minimal pleural effusion (mini-PE). Previous retrospective studies associate significantly shorter survival in mini-PE than stage-matched cases without mini-PE and hypothesise this reflects occult pleural metastases (OPM) in up to 80% of patients. STRATIFY (Staging by Thoracoscopy in Potentially Radically Treatable Non-Small Cell Lung Cancer (NSCLC) Associated with Minimal Pleural Effusion) is a multicentre, prospective observational study, which will determine the true prevalence of OPM in this setting. An update on the study is provided here.MethodsSTRATIFY was funded by Chief Scientist Office and opened to recruitment in Jan-20. Target n=96 across 8 UK centres in 18 months. Key eligibility criteria include Mini-PE (defined by an ipsilateral effusion <1/3 hemithorax on chest radiograph), radically treatable NSCLC and LAT feasibility (defined by sufficient fluid ± lung sliding on screening ultrasound). Primary endpoint: Prevalence of OPM, defined as NSCLC cells in parietal pleural biopsies. Key secondary endpoints include LAT safety, the impact of LAT results on NSCLC treatment plans and non-invasive MRI-derived measures of cardiac function and altered body composition (as alternative explanations for mini-PE). Study progress, including the impact of COVID19 was reviewed and summarised.ResultsSTRATIFY was rapidly halted due to COVID19 after 1 patient was recruited. The study was allowed to reopen in July-20 but given a dramatic reduction in lung cancer referrals across the UK and delayed site set up processes, the study team took the decision to close recruitment from Oct-20 to Apr-21. This was supported by the funder who provided a costed 6-month extension. By June-21, 4/8 sites have opened. 4/6 six screened patients have been recruited, 2/4 have entered the MRI sub-study.ConclusionsSTRATIFY will determine the true prevalence of OPM in patients with radically treatable NSCLC and mini-PE. The study outcomes will be important in defining an extended role for LAT as a pleural staging tool.