Changes in the Management of Patients having Radical Radiotherapy for Lung Cancer during the First Wave of the COVID-19 Pandemic in the UK.

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.

The impact of corona virus disease- 2019 on breast services at university hospitals of North Midlands, United Kingdom

Introduction: The COVID-19 pandemic has disrupted routine cancer care and training globally. Breast units adopted modified national guidelines in the UK, and significant changes were implemented to ensure the safety of patients and staff. The national breast screening services were temporarily suspended from March 2020. Patients underwent surgery in COVID-19 free zones. Complex oncoplastic procedures and immediate reconstructions were not offered. Adjuvant treatments were modified to reduce the risk of complications and hospital readmission. The objective of our study is to assess the impact of COVID-19 on breast cancer management and surgical training. Methods: The resource reallocation was implemented for 100 days, commencing from the 16th of March,2020. Patients diagnosed with breast cancer during this period were identified from the cancer database, and a comparison was made with patients diagnosed last year within the same time frame. We assessed the time taken from the decision to treatment and modifications made to cancer management due to the pandemic. The impact on resident training was evaluated by comparing the number of cases performed or assisted during this period. Results: During the pandemic period, out of 1064 patients seen in the Breast one-stop clinic, 64 patients (6.0%) were diagnosed with breast cancer. During the same time frame in 2019, out of 1881 new symptomatic patients, 90 (4.8%) were diagnosed with cancer. In 2019, sixty-three patients were treated for screen-detected cancer, whereas only 23 patients entered the screening pathway before the services were suspended. Majority of patients underwent surgery in 2019 as compared to 2020 (80% versus 36%). Fifty-six percent of patients received endocrine treatmentas primary or bridging therapy;whereas, in 2019, only 12% received primary endocrine therapy. In 2020, time fromdecision to surgical treatment has decreased by half as compared to 2019 (8.6 versus 19.1 days). One patient whounderwent surgery developed COVID-19 infection after two weeks, and no postoperative mortality was reported. Onaverage, each trainee was involved in 35 procedures during 2020;whereas in 2019, 54 procedures were assisted orperformed by a trainee. Conclusion: Our study shows that COVID-19 has made a significant impact on patients'management and surgical training. Majority of the patients were commenced on neoadjuvant endocrine therapyinstead of surgery. The conversion rate to cancers in one-stop clinic improved possibly due to a smaller number of benign referrals during the pandemic. The impact on surgical training is due to the reduction in the number of patients operated during this period, and constraints of performing complex oncoplastic procedures and breastreconstruction.