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Covid-19: Use radiotherapy only if “unavoidable,” says NICE

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1338 (Published 01 April 2020) Cite this as: BMJ 2020;369:m1338

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  1. Elisabeth Mahase
  1. The BMJ

Patients should be treated with radiotherapy only if it is “unavoidable,” and even then the “shortest safe form of treatment” should be used, rapid covid-19 guidance from the National Institute for Health and Care Excellence has said.

The guidance said that radiotherapy should be avoided if the evidence suggested that there would be “little to no benefit or if an alternative treatment is available” or should be deferred if clinically appropriate.1

NICE also issued guidance on bone marrow transplants in light of the pandemic, in which it said that clinicians should “consider both the severity of the disease and the post transplant risks of covid-19 when deciding on treatment plans.”2 For patients set to receive a stem cell transplant from a donor, clinicians have been told to “defer most non-urgent cases,” including those for chronic blood cancers, until the risks associated with covid-19 have passed.

Both sets of guidance also included advice on how to minimise the risk of covid-19 in patients who still need to be seen. NICE recommended offering telephone or video consultations whenever possible and minimising the time patients spend in the waiting room by encouraging them not to arrive early or allowing them to wait in their cars and texting them when their appointment is ready to begin.

The guidance recommended scheduling patients based on their covid-19 status as well as using separate entrances or facilities for patients who have confirmed or suspected covid-19. Patients are asked to attend radiotherapy appointments without family members or carers if possible; patients receiving stem cell transplants are asked to attend “with no more than one family member or carer, or alone if they can.”

NICE said, “The purpose of this guideline is to maximise the safety of patients who need radiotherapy [or haemopoietic stem cell transplantation] and make the best use of NHS resources, while protecting staff from infection. It will also enable services to match the capacity for radiotherapy [or transplantation] to patient needs if services become limited because of the covid-19 pandemic.”

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