Evidence map›Paper›PMID 33493433›Full record

ArticleThe Lancet. Oncology2021

The impact of the COVID-19 pandemic on radiotherapy services in England, UK: a population-based study.

Katie Spencer, Christopher M Jones, Rebecca Girdler, Catherine Roe, Michael Sharpe, Sarah Lawton, Louise Miller, Philippa Lewis, Mererid Evans, David Sebag-Montefiore and 3 more

Erratum issuedOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 105 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
105citing papers in PubMed, 4 pooled it
12.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

105 citing papers in PubMed, 4 syntheses or guidelines pooled it, 166 citations in OpenAlex.

  1. Pooled it
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  8. Faculty of Radiation Oncology 2022 New Zealand Workforce Census.Journal of medical imaging and radiation oncology · 2026
    Article
  9. The landscape of definitive radiotherapy discontinuation: a 5-year institutional audit and clinical profiling.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
    Article
  10. Viewpoint: Optimising Cancer Treatment to Reduce Its Environmental Impact.Journal of medical imaging and radiation oncology · 2026
    Article
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  15. Faculty of Radiation Oncology 2022 Workforce Census.Journal of medical imaging and radiation oncology · 2025
    Review
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45 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 8 institutions in 1 country.

Katie SpencerFaculty of Medicine and Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: k.spencer@leeds.ac.uk.
Christopher M JonesFaculty of Medicine and Health, University of Leeds, Leeds, UK; Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Rebecca GirdlerNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Catherine RoeNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Michael SharpeNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Sarah LawtonNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Louise MillerNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Philippa LewisNHS England, London, UK; Royal College of Radiologists, London, UK.
Mererid EvansVelindre University NHS Trust, Cardiff, UK.
David Sebag-MontefioreFaculty of Medicine and Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Tom RoquesRoyal College of Radiologists, London, UK; Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Rebecca SmittenaarNational Cancer Registration and Analysis Service, Public Health England, London, UK.
Eva MorrisNuffield Department of Population Health, University of Oxford, Oxford, UK.
Public Health England · GBLeeds Teaching Hospitals NHS Trust · GBNational Cancer Registration Service · GBNHS EnglandRoyal College of Radiologists · GBUniversity of Leeds · GBUniversity of Oxford · GBVelindre NHS Trust · GB

Funding

Wellcome TrustWellcome Trust 203914/Z/16/Z
6 · The paper itself

Abstract

backgroundThe indirect impact of the COVID-19 pandemic on cancer outcomes is of increasing concern. However, the extent to which key treatment modalities have been affected is unclear. We aimed to assess the impact of the pandemic on radiotherapy activity in England.

methodsIn this population-based study, data relating to all radiotherapy delivered for cancer in the English NHS, between Feb 4, 2019, and June 28, 2020, were extracted from the National Radiotherapy Dataset. Changes in mean weekly radiotherapy courses, attendances (reflecting fractions), and fractionation patterns following the start of the UK lockdown were compared with corresponding months in 2019 overall, for specific diagnoses, and across age groups. The significance of changes in radiotherapy activity during lockdown was examined using interrupted time-series (ITS) analysis.

findingsIn 2020, mean weekly radiotherapy courses fell by 19·9% in April, 6·2% in May, and 11·6% in June compared with corresponding months in 2019. A relatively greater fall was observed for attendances (29·1% in April, 31·4% in May, and 31·5% in June). These changes were significant on ITS analysis (p<0·0001). A greater reduction in treatment courses between 2019 and 2020 was seen for patients aged 70 years or older compared with those aged younger than 70 years (34·4% vs 7·3% in April). By diagnosis, the largest reduction from 2019 to 2020 in treatment courses was for prostate cancer (77·0% in April) and non-melanoma skin cancer (72·4% in April). Conversely, radiotherapy courses in April, 2020, compared with April, 2019, increased by 41·2% in oesophageal cancer, 64·2% in bladder cancer, and 36·3% in rectal cancer. Increased use of ultra-hypofractionated (26 Gy in five fractions) breast radiotherapy as a percentage of all courses (0·2% in April, 2019, to 60·6% in April, 2020; ITS p<0·0001) contributed to the substantial reduction in attendances.

interpretationRadiotherapy activity fell significantly, but use of hypofractionated regimens rapidly increased in the English NHS during the first peak of the COVID-19 pandemic. An increase in treatments for some cancers suggests that radiotherapy compensated for reduced surgical activity. These data will assist health-care providers in understanding the indirect consequences of the pandemic and the role of radiotherapy services in minimising these consequences.

fundingNone.

Indexed as

SARS-CoV-2AdultAgedCOVID-19FemaleHumansMaleMiddle AgedNeoplasmsUnited Kingdom

Identifiers

PMID33493433
PMCPMC7825861
OpenAlexW3121958975

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.