Why radiotherapy is crucial for cancer patients during and post Covid-19

Virtually every aspect of healthcare has been affected by the coronavirus pandemic and cancer care is no exception. People with cancer are a high-risk group which, in combination with other mitigation efforts, has resulted in postponed screenings and delayed diagnosis and treatments. Listening to care providers across the world, a number of hurdles have been identified:

• Many cancer therapies, including chemotherapy and some targeted therapies, are immunosuppressive and put patients at high risk of infection.
• Shelter-in-place guidelines make it difficult for patients to travel to cancer care centres
• Hospitals and cancer centres are striving to reduce traffic through their facilities from non-essential staff and vendors/repair technicians, while still providing critical therapy for people with cancer.
• Lack of personal protection equipment and testing for the staff.

Postponed treatments may have severe consequences in terms of outcomes. Late diagnoses or delayed treatments can result in tumour progression and worsened prognoses; they also cause huge backlogs of treatment needs, to be dealt with later by the healthcare providers.

Recent studies estimate that the delay of cancer diagnosis and treatment will raise the indirect death toll[1],[2] of Covid-19 by several thousand in the coming years.

But which of these treatments need to be postponed?

Studies have shown that radiotherapy is less immunosuppressive than other treatments and can continue to be given.[3] This is very good news since about 50-60% of patients with cancer will receive radiation therapy at some point during their cancer journey and it is involved in 40% of cancer cures. Radiotherapy can also be used earlier in multi-modal therapy to avoid immunosuppression associated with many chemotherapy regimens and to delay surgery to avoid operating room and anaesthesia constraints. Another aspect is that radiotherapy generally does not compete for in-demand resources, such as respirators or intensive care unit beds. It is mostly conducted in an out-patient setting; it can and should, therefore, continue to remain accessible.

We can also see a trend that the use of advance precision radiotherapy techniques enabling effective radiation therapy over fewer treatment sessions have increased tremendously:

• They reduce the number of times a patient needs to leave home for cancer therapy.
• They reduce traffic through care centres and the per-patient staff burden.

Another trend that emerged during the pandemic is the use of telemedicine for consulting patients, tumour board meetings and treatment planning. Cloud-based and remote systems allow effective care to be delivered with fewer onsite personnel requirements, reducing onsite space requirements, and giving personnel improved flexibility and work-life balance.

To minimise the downtime of radiotherapy systems, without the need for onsite maintenance activity, there are remote and automated monitoring solutions that can predict the potential failure of radiation delivery equipment.

Radiation as a therapy has been a pillar of cancer treatment for most of the past century, yet the way that it is delivered has been totally transformed. Recent advances in radiation delivery technology and software automation have enabled a new era of personalised precision radiation medicine.

This pandemic must serve as a driver for a faster uptake of technology and techniques. In the case of cancer care during Covid-19, the technology we need is already here. The challenge is to re-invent our approach to using it.