The changing face of cancer treatment in our new normal

Ananya Choudhury, Chair and Honorary Consultant in Clinical Oncology, looks at how cancer treatment is adapting in a world where COVID-19 looms large.

The COVID-19 pandemic is forcing a change to the face of cancer treatment and routine practices.

Thinking differently about how we work to keep patients and practitioners safe, while accelerating detection and treatment caused by delayed diagnosis, is critical to ensuring that the cancer pathway opens up again.

Manchester is leading the way in delivering cancer treatment differently, including in radiotherapy – providing bigger doses over a smaller number of visits but with the same outcome. 

Hypofractionated radiotherapy is just one way that cancer treatment in Manchester is becoming become more agile as clinical staff create new, flexible protocols to give treatments that are effective, safe for patients and staff, and COVID secure.  

Recorded in August 2020


Lecture transcript

The COVID-19 pandemic has been a particularly challenging time I think for all of us, everybody in the country.

With respect to us who are doing clinical research, the main issue has been how do we ensure that we can give treatments that are effective, but also safe for patients, in light of being COVID secure.

Initially, we were very worried that cancer patients who were having treatment could be at greater risk of infection and also the serious symptoms of infection. But there's been a lot of data collected in the UK, that's actually recently been published in The Lancet, which has been a collaboration right across the country of clinicians everywhere collecting data on patients who've been treated during the past few months who have been COVID positive.

And what we've found is that if you are safe and if you are careful, then you can actually deliver all of our cancer treatments in a very safe way. And that has been very reassuring, I think, for all of us who are treating patients on a daily basis and I think that's a great piece of research where so many people have taken part to really improve our knowledge base and also use that knowledge to ensure that we're treating patients in the best way that we can.

We've also looked at ways of delivering radiotherapy better, again to try and reduce the footfall in the hospital so that patients have fewer visits. We've looked at using ways of giving radiotherapy so that we give a bigger dose for each visit but we reduce the number of visits overall. This is called hypofractionated radiotherapy and it's something that actually we've been doing in Manchester for many years.

So, in some ways we've been able to use our experience that we've gained over decades to help other centres, who are less familiar with hypofractionated radiotherapy, to deliver protocols safely in these new centres. There have been a number of publications in the last couple of months focusing in this area, in particular because my interest is urological cancers, we've published guidelines for prostate cancer and also for bladder cancer which has shown how you can deliver shorter courses of radiotherapy safely but getting good outcomes at the same time.

I think a number of changes are required as we go into what we're calling "the new normal". We need a change in culture. We need to be able to be agile and react to the differing circumstances that we're facing sometimes on a day-by-day basis. As we've seen, the infection rate can rise and fall quite dramatically and sometimes unexpectedly as we ease lockdown and then lockdown has to be reinforced and we need to be able to react to those changes in public health policy so that we again are treating our patients properly and in the best way that we can.

I think there are lots of examples where we've actually been better than maybe many of us thought we could be in that area. For example, again, you know, being able to switch from longer radiotherapy courses to shorter radiotherapy courses in a short period of time is something that we probably haven't had to do in the past.

Some of those changes would have taken months and years to implement and we've literally done it in weeks. But at the same time, there have been challenges that have proven more difficult, for example the social distancing, all of the hygiene protocols that we have to instigate for our patients who are being treated or imaged on a daily basis does mean that we can't treat or image as many patients as we used to.

You know, at present a lot of services are running at far less than 100 percent capacity and how we deal with that as a society is going to be difficult. It's hard to suddenly increase the resources when you weren't expecting to need to increase the resources. So I think there are going to be lots of challenges that we have that we're going to have to find very creative solutions for.

One of the things that has been particularly interesting and innovative is the way that we've moved from doing face-to-face consultations to virtual consultations.

We've been doing a lot more telephone follow-up to talk to our patients and, where possible, video appointments but these can sometimes be difficult and aren't to everybody's preference. I think a lot of clinicians and patients find the face-to-face contact, the non-verbal communication and the way that you can build a relationship when you meet somebody in the clinic very useful and it feeds into the way that we interact with each other and we can't always do that over virtual consultations.

So, I think what we are trying to do is finding a way of seeing our patients, even if it's virtual, in order to work out which patients we then need to see face-to-face. I think it is important though for all of us to realise that there are risks in everything that we do and hopefully, as people get more used to living in a COVID-19 world, our patients will realise that it is safe to come and see doctors and nurses and have treatments in hospital and realise that that we are doing things in a way that is protecting them as well as delivering their treatment.

I think there's a lot of work to be done on looking at the patient experience and how both the clinical teams and the patients are finding these sorts of changes in the way that we see and do things. What we've learned over the last few months of the pandemic is that we can do things differently if we need to and I think various people have come together and worked very effectively as a team, even when maybe they haven't worked together before.

One area I'd particularly like to highlight is the international collaboration that we've had. We have been fortunate enough to have international colleagues reach out to us and us out to them so that we've come together and produced, not only guidelines and recommendations for the treatment of patients that can be accessible to anyone anywhere in the world, but also we've then discussed research ideas and looked to see it whether we can have data collections that will allow us to get more information at an international level.

For example, my team is involved in collecting data at a global level for the outcomes for bladder cancer and it will be really interesting to see what sort of effect the pandemic has had on the treatment for this group of patients and outcomes over the next few months.