Shortening radiotherapy treatment courses benefits patients and NHS, NICE says

New guidance published by NICE suggests that patients with invasive breast cancer having surgery should attend radiotherapy appointments over the course of one week rather than three.

The new guidance comes following the Covid pandemic, which saw a change as to how radiotherapy services were delivered.

For every 1,000 patients adhering to the new guidance, 10,000 more radiotherapy appointments have been freed up

Before the Covid pandemic, guidance suggested that people with invasive breast cancer having surgery should have 15 radiotherapy treatments (or fractions) giving a total of 40 units of radiation over three weeks.

When the pandemic first began, this guidance changed to reduce the risk of vulnerable cancer patients catching Covid and to reduce pressure on hospitals.

As routine practice, NHS hospitals began offering breast cancer patients five radiotherapy treatments giving a total of 26 units of radiations over the course of one week.

The latest clinical trial evidence suggests this practice was safe, and did not show any difference in terms of breast cancer-related mortality or disease recurrence between a higher dose and longer intensity of radiotherapy treatment and a lower dose shorter intensity of radiotherapy treatment.

For this reason, NICE has now enshrined this practice in its own guidance. NICE also notes that the practice had benefits for the NHS as a whole, as well as for patients themselves.

Indeed, shortening the intensity and duration of radiotherapy means that for every 1,000 people receiving the lower number of fractions, 10,000 NHS radiotherapy appointments have been freed up in England every year, reducing pressure on services and allowing the NHS to see more people.

However, certain patients (including those who have a diagnosis that increases sensitivity to radiotherapy, have had implant–based reconstruction or a high BMI) can still access a higher dose and intensity of radiotherapy over a three course, if more appropriate.

The new guidance is already “reaping rewards”

Jonathan Benger, NICE’s chief medical officer, said this new guidance is already having positive effects on the NHS and is making it easier for patients to access the treatment they need.

“Lower intensity, shorter duration radiotherapy in response to pandemic pressures and NICE’s rapid Covid-19 guidelines for some people with invasive breast cancer is now embedded in practice and already reaping rewards.

“Apart from enabling the NHS to make efficiencies, save money and free up services, it’s likely most people will prefer to attend radiotherapy appointments over the course of one week, rather than over three weeks for practical reasons related to fewer trips to the hospital – for example, reduced travelling time and costs, less time off work or from caring responsibilities,” he said.