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THREAD on cancer treatment in #COVID19 pandemic.
The @CovidSurg collaborative have estimated that in the UK, >500,000 operations have been cancelled, including 36,000 cancer surgeries. Globally, the figures are 28.4m and 2.3m. (During peak 12 weeks of disruption) #cancer 1/
Although surgical activity is increasing again and cancer surgery is being prioritised, we are far from returning to normal levels and there is going to be an enormous backlog of cases. This will be particularly detrimental to overall cancer outcomes 2/
It gets worse. We now have data via @CovidSurg (across a range of different types of surgery) that shows a 30-day mortality rate of 23.8% in patients who develop #COVID19 infections in the post-operative period. Mortality rates of 30% have been reported after cancer surgery 3/
It’s important to understand that this high mortality rate is only in those who develop #COVID19 infections. However, this is going to be an ongoing serious problem to deal with because #COVID19 is now endemic in our society and our hospitals. Surgeons are in a difficult place 4/
A key way to mitigate this is to use “COVID19 free” surgical hubs and private hospitals. However, they will not remain #COVID19 free for long, due to the nature of how this virus spreads. “Test, test, test” & isolating also help reduce risks, but testing is not 100% effective 5/
Another crucial way to address the problem is to offer #radiotherapy as alternative to surgery. This is already happening to a certain point extent, but NHS England needs to ramp this up and support the radiotherapy community much more #radonc 6/
In normal times, radiotherapy is good alternative to surgery in a range of different cancers such as lung, prostate, bladder, head & neck, cervix, oesophagus, anal, kidney and liver cancer. In view of the current risks with surgery, the case for radiotherapy is even greater 7/
In fact, radiotherapy techniques such as stereotactic body radiotherapy (#SABR or #SBRT) now have an absolutely key role to play in this national emergency. SABR can be delivered in 1 to 5 short outpatient visits compared to conventional radiotherapy’s 20-30 treatments #radonc 8/
SABR not only frees up radiotherapy capacity, but also reduces risks of viral exposure to patients & staff due to the reduced number of hospital visits. The UK radiotherapy community has already developed newer schedules with even fewer visits eg… 9/
We can now even treat selected patients with early stage lung cancers with a single treatment of radiotherapy (radiosurgery). Patients can be in and out of the hospital in 30mins! #RadOnc #Lcsm #10
The good news is that every UK radiotherapy centre has the facilities to deliver #SABR. The bad news is that @NHSEngland has only allowed about half of UK centres to deliver it. This needs to change and it needs to change now. Put pressure on them, but retweeting this #RadOnc 11/
I believe that through collaboration and “buddying” between radiotherapy centres, we can get SABR services up and running in virtually every UK radiotherapy centre within 3 months, to help deal with the big wave of cancer that is coming at us as lockdown eases #radonc 12/
I’d also strongly argue that centres who don’t have 4D CT availability or capacity can still do lung #SABR. I have data from over 400 patients to prove this.
Prostate SABR doesn’t need 4D anyway, so all centres can do it by following PACE B protocol and getting training & QA 13/
The stumbling block to dealing with this ongoing cancer emergency is @NHSEngland. It’s time for them to get behind the UK radiotheray community. We have made enormous strides in hi-tech Radiotherapy and opening up capacity. They must help us to get every UK center doing SABR 14/
#SABR is also more cost effective than conventional radiotherapy. All we need from @NHSEngland is the support to do radiotherapy teaching, training and quality assurance, through #telemedicine. A few centres need some sort extra kit too. Give us the green light #nobrainer 15/
Finally, this is why we have the capacity to help deal with cancer backlog. These are the 3 commonest cancers that traditionally used 2/3 of all radiotherapy capacity:
Lung cancer: Now 1-5 treatments, previously 20-30
Breast: 5, previously 15
Prostate: 5, previously 20-37
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