NICE guidelines on delivering radiotherapy during COVID-19 pandemic

  • National Institute for Health and Care Excellence

  • Oncology guidelines update
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NICE has issued guidance on the use of radiotherapy for cancer patients during the COVID-19 outbreak.

Key recommendations include the following:

  • Communicate with patients and support their mental well-being.
  • Minimise face-to-face contact.
  • Advise patients to contact their cancer team rather than NHS 111 if they feel unwell, to ensure symptoms are appropriately assessed.
  • For patients not known to have COVID-19, ask them to attend appointments alone if possible.
  • Minimise time in the waiting area.
  • COVID‑19 alone is not a reason to cancel radiotherapy.
  • Be aware that immunosuppressed patients may have atypical presentations.
  • For immunosuppressed patients having radiotherapy who have a fever with/without respiratory symptoms, suspect neutropenic sepsis and treat appropriately.
  • Ensure treatment schedules accommodate cleaning needs.
  • Prioritise treatment as follows:

Priority 1

  • Radical radiotherapy or chemoradiotherapy with curative intent, if: the patient has a category 1 tumour and treatment has already started and there is little or no possibility of compensating for treatment gaps.
  • External beam radiotherapy with subsequent brachytherapy, if: the patient has a category 1 tumour and external beam radiotherapy has already started.
  • Radiotherapy that has not started yet, if: the patient has a category 1 tumour and they would normally start treatment, based on clinical need or current cancer treatment waiting times.

Priority 2

  • Urgent palliative radiotherapy for patients with malignant spinal cord compression who have salvageable neurological function.

Priority 3

  • Radical radiotherapy for a category 2 tumour, if radiotherapy is the first treatment with curative intent.
  • Post-operative radiotherapy, if the patient has a tumour with aggressive biology or have had surgery, but there is known residual disease.

Priority 4

  • Palliative radiotherapy, where improving symptoms would reduce the need for other interventions.

Priority 5

  • Adjuvant radiotherapy if the disease has been completely resected and there is
  • Radical radiotherapy for prostate cancer, in patients having neoadjuvant hormone therapy.