Guidelines for Radiation Therapy with COVID-19 Urge Less Treatment

New guidelines for radiation oncologists suggest that, during the COVID-19 pandemic, interactions with healthcare professionals should be done remotely where possible, and treatments should be avoided or delayed to minimize strains on the system and risks to the patient.

The guidelines, “Prostate Cancer Radiotherapy Recommendations in Response to COVID-19,” were published in the journal Advances in Radiation Oncology.

Radiation therapy is a common part of prostate cancer treatment. However, it requires repeat visits to a hospital, which could cause undue risks under the ongoing COVID-19 outbreak.

Routine hospital trips raise the risk of exposure to the virus, and people with cancer may be more likely to have serious complications if infected. Undergoing radiation therapy during the pandemic also puts demands on hospital resources, both equipment and personnel, already dealing with an unexpected influx of  with COVID-19 needing care.

“The decision to delay life-saving cancer treatment in a time of a resource-intensive pandemic represents a clinical conundrum without modern precedent,” the prostate cancer experts in the U.S. and U.K. who developed the guidelines wrote.

“As prostate cancer therapy has advanced, it has also become more complex, with increasing use of advanced imaging and other techniques that require extra procedures and visits, many of which require the use of masks, gloves and other types of protective equipment that are currently needed by frontline providers,” Daniel Spratt, MD, a professor at University of Michigan and co-author of the guidelines, said in a news story.

Aiming to inform the management of prostate cancer patients needing radiotherapy during this pandemic, the guidelines recommend oncologists to follow a framework called RADS, named for its four principle components: Remote visits, Avoidance, Deferment, and Shortening of radiotherapy.

Remote visits are urged wherever possible. This largely includes telemedicine, in which patients consult with their healthcare providers via phone or a video chat. For patients who must be seen, the guidelines stress the importance of social distancing, such as limiting the numbers of visitors a patient has, or  having patients wait to be seen in their cars when possible.

The guidelines suggest avoidance of radiotherapy for people whose cancer is deemed relatively low-risk. Data suggest that these patients may have a good prognosis if put under active monitoring without therapeutic intervention. As such, the potential risks of coming in for treatment likely outweigh the benefits for this group.

“We issued these recommendations assuming that the pandemic will last for at least several months, with multiple waves of varying length, and place new overall stress on hospital systems, along with causing disruptions to hospital staffing from illness, quarantine and family responsibilities,” Spratt said

For individuals with higher-risk prostate cancer, the guidelines recommend that radiation therapy be deferred as much as possible to limit the number of patient visits to a hospital. This may also include giving other treatments, androgen deprivation therapy, that do not require regular hospital visits or can be handled remotely.

When radiation is justified, the guidelines suggest that it should be shortened as much as possible to limit the amount of time a person spends in the hospital, and avoiding procedures without clear therapeutic benefit.

“These recommendations are not formal rules or policies, as we do not believe this is possible when data is so limited,” the team wrote. “Importantly, these recommendations apply only to patients not infected with COVID-19. For patients who have symptoms concerning for COVID-19, or who have tested positive already, please follow local hospital plans and procedures.”

“The COVID-19 pandemic is presenting new challenges for providers who care for all types of cancer patients, and creating difficult decisions around providing the most beneficial care while managing the risks and strains on the health care system caused by the outbreak,” Spratt said.

“Our goal was to quickly provide a framework based on the most up-to-date research to help guide treatment decisions for prostate cancer patients around the globe,” he added.

According to Spratt, the recommendations are already being used by U.K.’s National Institute for Health and Care Excellence (NICE) and NHS England.