1
|
Fornacon-Wood I, Banfill K, Ahmad S, Britten A, Carson C, Dorey N, Hatton M, Hiley C, Thippu Jayaprakash K, Jegannathen A, Kidd AC, Koh P, Panakis N, Peedell C, Peters A, Pope A, Powell C, Stilwell C, Thomas B, Toy E, Wicks K, Wood V, Yahya S, Price G, Faivre-Finn C. Impact of the COVID-19 Pandemic on Outcomes for Patients with Lung Cancer Receiving Curative-intent Radiotherapy in the UK. Clin Oncol (R Coll Radiol) 2023; 35:e593-e600. [PMID: 37507280 DOI: 10.1016/j.clon.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
AIMS Previous work found that during the first wave of the COVID-19 pandemic, 34% of patients with lung cancer treated with curative-intent radiotherapy in the UK had a change to their centre's usual standard of care treatment (Banfill et al. Clin Oncol 2022;34:19-27). We present the impact of these changes on patient outcomes. MATERIALS AND METHODS The COVID-RT Lung database was a prospective multicentre UK cohort study including patients with stage I-III lung cancer referred for and/or treated with radical radiotherapy between April and October 2020. Data were collected on patient demographics, radiotherapy and systemic treatments, toxicity, relapse and death. Multivariable Cox and logistic regression were used to assess the impact of having a change to radiotherapy on survival, distant relapse and grade ≥3 acute toxicity. The impact of omitting chemotherapy on survival and relapse was assessed using multivariable Cox regression. RESULTS Patient and follow-up forms were available for 1280 patients. Seven hundred and sixty-five (59.8%) patients were aged over 70 years and 603 (47.1%) were female. The median follow-up was 213 days (119, 376). Patients with stage I-II non-small cell lung cancer (NSCLC) who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.859) or death (P = 0.884); however, they did have increased odds of grade ≥3 acute toxicity (P = 0.0348). Patients with stage III NSCLC who had a change to their radiotherapy had no significant increase in distant relapse (P = 0.216) or death (P = 0.789); however, they did have increased odds of grade ≥3 acute toxicity (P < 0.001). Patients with stage III NSCLC who had their chemotherapy omitted had no significant increase in distant relapse (P = 0.0827) or death (P = 0.0661). CONCLUSION This study suggests that changes to radiotherapy and chemotherapy made in response to the COVID-19 pandemic did not significantly affect distant relapse or survival. Changes to radiotherapy, namely increased hypofractionation, led to increased odds of grade ≥3 acute toxicity. These results are important, as hypofractionated treatments can help to reduce hospital attendances in the context of potential future emergency situations.
Collapse
Affiliation(s)
| | - K Banfill
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - S Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Britten
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Carson
- The Northern Ireland Cancer Centre, Belfast, UK
| | - N Dorey
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - C Hiley
- University College London Hospitals, London, UK
| | - K Thippu Jayaprakash
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Jegannathen
- University Hospitals North Midlands, Stoke on Trent, UK
| | | | - P Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Panakis
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - C Peedell
- The James Cook University Hospital, Middlesborough, UK
| | - A Peters
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Pope
- Clatterbridge Cancer Centre, Liverpool, UK
| | - C Powell
- Velindre Cancer Centre, Cardiff, UK
| | | | - B Thomas
- Swansea Bay University Hospital, Swansea, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - K Wicks
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - V Wood
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - S Yahya
- University Hospitals Birmingham, Birmingham, UK
| | - G Price
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
2
|
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 SY, Price G, Faivre-Finn C. Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK. Clin Oncol (R Coll Radiol) 2022; 34:19-27. [PMID: 34763964 PMCID: PMC8552552 DOI: 10.1016/j.clon.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/15/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022]
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.
Collapse
Affiliation(s)
- K Banfill
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - W Croxford
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - K Wicks
- The University of Manchester, Manchester, UK
| | - S Ahmad
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Britten
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C Carson
- The Northern Ireland Cancer Centre, Belfast, UK
| | - N Dorey
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - C Hiley
- University College London Hospitals, London, UK
| | - K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Jegannathen
- University Hospitals North Midlands, Stoke-on-Trent, UK
| | - P Koh
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - N Panakis
- Oxford Universities NHS Trust, Oxford, UK
| | - C Peedell
- The James Cook University Hospital, Middlesbrough, UK
| | - A Pope
- Clatterbridge Cancer Centre, Bebington, UK
| | - C Powell
- Velindre Cancer Centre, Cardiff, UK
| | | | - B Thomas
- Swansea Bay University Hospital, Swansea, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - V Wood
- University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - S Yahya
- University Hospitals Birmingham, Birmingham, UK
| | - S Y Zhou
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - G Price
- The University of Manchester, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| |
Collapse
|
3
|
Price J, Fornacon-Wood I, Thomson D, Lee L, Sykes A, Garcez K, Price G, McPartlin A. PO-1001 The effect of switching to carboplatin chemo-RT for cycle 2 in cisplatin-ineligible HNSCC patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
4
|
Fornacon-Wood I, Mistry H, Johnson-Hart C, O’Connor J, Faivre-Finn C, Price G. PD-0776 A Bayesian approach to evaluate the impact of change in IGRT protocol using real world data. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07055-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
5
|
croxford W, Banfill K, Fornacon-Wood I, Britten A, Carson C, Hatton M, Thippu Jayaprakash K, Jegannathen A, Keng Koh P, Panakis N, Peedell C, Pope A, Powell C, Stilwell C, Thomas B, Wood V, Yun Zhou S, Price G, Faivre-Finn C. PO-1198 Changes in radical radiotherapy for lung cancer patients in the UK during the COVID-19 pandemic. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
6
|
Ackermann C, Fornacon-Wood I, Tay R, Manoharan P, Price G, Lindsay C, Faivre-Finn C, Blackhall F, Cobben D. P1.04-44 Radiomics for Predicting Response to First-Line Anti-PD1 Therapy in Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|