8 Modifications to usual care

8 Modifications to usual care

8.1 Think about how to modify usual care to reduce patient exposure to COVID‑19 and make best use of resources (workforce, facilities, anaesthetics, equipment).

8.2 Centres should discuss changes to standard cancer treatment pathways within their operational delivery networks. This may include discussing alternative dose fractionation schedules or radiotherapy techniques with appropriately experienced centres, if a radiotherapy technique is not available locally.

8.3 Centres should work with their operational delivery networks and/or cancer alliance to manage capacity issues across their area.

8.4 Make policy decisions about modifying usual care at an organisational level.

8.5 When modifying individual patients' treatment plans:

  • take their clinical circumstances into account

  • involve all relevant members of the multidisciplinary team in the decision

  • record the reasoning behind each decision.

8.6 When treatment has to be interrupted because of COVID‑19, use the Royal College of Radiologists' guidance on the management of unscheduled treatment interruptions to help make decisions.

8.7 Use the RADS (Remote, Avoid, Defer, Shorten) principle to help plan individual patient treatment:

  • Remote visits: use phone or video assessments instead of face-to-face contact.

  • Avoid radiotherapy: avoid treatment if the evidence suggests there will be little to no benefit, or if an alternative treatment is available.

  • Defer radiotherapy: defer treatment if clinically appropriate. Use table 1 on prioritising radiotherapy treatments.

  • Shorten radiotherapy: if treatment is unavoidable, use the shortest safe form of treatment.

    [the RADS principle is adapted with permission from Spratt D, Dess R et al. (2020) Prostate Cancer Radiotherapy Recommendations in Response to COVID-19. Advances in Radiation Oncology (in press)]

8.8 The Royal College of Radiologists has created a set of resources on cancer treatment (including hypofractionation) during the COVID-19 pandemic.

8.9 Discuss the risks and benefits of changing treatment schedules or interrupting treatment with patients, their families and carers.