Managing Treatment for Patients with Prostate Cancer During the COVID-19 Pandemic

A group of radiation oncologists from the United States and United Kingdom developed a framework to assist in the decision-making process in regard to radiation treatment for patients with prostate cancer during the global COVID-19 pandemic, according to a study pre-printed in Advances in Radiation Oncology.¹

The framework, deemed the “RADS framework,” stands for “Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy.” It was determined that all aspects of patient visits, treatment, and overall resource utilization should be reduced when possible for all stages of radiotherapy, but not to the detriment of the patient.

“We issued these recommendations assuming that the pandemic will last for at least several months, with multiple waves of varying length, and place new overall stress on hospital systems, along with causing disruptions to hospital staffing from illness, quarantine and family responsibilities,” corresponding study author Daniel Spratt, MD, said in a news article.²

The framework recommends protecting patients, care providers and society through “increased use of telemedicine consultations,” while also avoiding, deferring and shortening radiotherapy whenever possible. The four main components of the RADS recommendations include remote visits, avoiding radiation, delaying treatment, and shorten radiotherapy treatments.

Rather than in-person visits, the researchers recommend conducting remote visits between doctors and patients to determine treatment whenever possible. More, when the evidence suggests there is little to no benefit, the researchers recommend patients avoid radiation.

Depending on each individual patient’s circumstances, delaying treatment would be beneficial for patients to avoid potential exposure to the COVID-19 virus. For patients whose disease is rapidly progressing, the researchers stress weighing the treatment against potential COVID-19 complications. Finally, the researchers recommend shortening radiotherapy treatment to the minimum number that is safe and effective for each particular patient.

“The complexity of treatment of prostate cancer has increased with more frequent use of advanced imaging, including MRI and molecular PET imaging, image guidance with fiducial markers, and rectal spacers, most of which require extra procedures or visits, and some of which require extra use of PPE,” wrote the researchers. “Thus, prostate cancer patients represent an important population that radiation oncology departments need to efficiently manage in times when resources are limited.”

The researchers found that consultation and return visits could safely be delayed between 1-6 months according to stage of the disease. For patients with very low, low, and favorable intermediate-risk disease, treatment can be avoided or delayed until the pandemic subsides.

The development of new recommendations came from analyzing national guidelines, systematic reviews, and previous or ongoing clinical trial data. The researchers were sure to stress that these new guidelines apply only to patients who have not yet tested positive for the COVID-19 virus. Those who have tested positive should continue following instructions from their local caretakers and health officials.

The researchers explained that these recommendations are possible because prostate cancer is a unique disease compared to other forms of cancer. Most prognoses are not aggressive, but for those that are, androgen deprivation therapy (ADT) can delay the start of radiotherapy for months. This allows for patients with prostate cancer to successfully wait for the pandemic to subside before resuming treatment.

“The goal was to provide guidance and a framework of thinking of how numerous programs are approaching the care of patients with prostate cancer at their own clinics, who are all at various stages of impact and restrictions from the COVID-19 global pandemic,” wrote the researchers.

References:

1. Zaorsky NG, Yu JB, McBride SM, et al. Prostate Cancer Radiotherapy Recommendations in Response to COVID-19. Advances in Radiation Oncology.

2. Demsky I. How Should Radiation Oncologists Manage Prostate Cancer Patients During the COVID-19 Pandemic? University of Michigan Health. March 26, 2020. https://labblog.uofmhealth.org/rounds/how-should-radiation-oncologists-manage-prostate-cancer-patients-during-covid-19-pandemic. Accessed March 31, 2020.