Review of Radiotherapy Activity in Scotland, 2 Years Post COVID

Now that the world has returned to normal following the COVID-19 pandemic, there are concerns that the pandemic has had a negative, ongoing effect on cancer care. This study aims to investigate the impact of the COVID-19 pandemic on radiotherapy services in Scotland.

Detailed quantitative data of radiotherapy activity at our centre were collected from 01/04/2021-31/03/2023, which cover the second and third 'post-COVID' years. Differences in total/mean weekly radiotherapy courses, dose and fractionation patterns, and treatment intent for all treatment sites were compared to data from the year before the COVID-19 pandemic and the first year of the COVID-19 pandemic (01/04/2019-31/03/2021).

Compared with the first year of the COVID-19 pandemic, the total number of radiotherapy courses increased from 6240 to 7899 (+32%) and 8188 (+35%) for the second and third years, respectively. Average weekly radiotherapy courses (AWRC) delivered increased from 120 (standard deviation [sd ± 15) during the COVID-19 pandemic to 152 (sd±15) and 157 (sd±19) in the two following years. In the two years post the COVID-19 pandemic, the total number of radical treatments increased from 5470 to 5912 (8.1%) and the total number of palliative treatments decreased from 2429 to 2206 (-9%). During the COVID-19 pandemic, a significantly greater reduction in radiotherapy utilisation was observed for females (3750-3156; -16%) than for males (3090-2839; -8%). In contrast, the two years post the COVID-19 pandemic have seen a significant increase in the number of women, with the total number of patients increasing to 4813 and 4860 (65-69%), receiving radiotherapy compared to male patients, with the total number of patients 3086 and 3256 (9-15%), respectively.

The two years post COVID-19 pandemic have seen a significant increase in radiotherapy activity compared to the first year of the COVID-19 pandemic and the year prior. The largest recoveries in radiotherapy delivery post the COVID-19 pandemic were observed in breast, cervical, rectal, and prostate cancer. Contrarily, a decrease in radiotherapy delivery was observed in patients with lung cancer. The increase in radiotherapy activity can likely be attributed to COVID-related suspensions of diagnostic tests, surgeries, and cancer screenings being reinstated.