By: Sally Wardle
- Bigger radiation doses in fewer sessions can be just as successful for treatment
- Trials are showing it to be safe, without additional side effects, despite concerns
- Findings of a new UK study has proved breast cancer can be beaten in a week
- Karen Davis’ radiotherapy took five days and she has stayed free from cancer
Thousands of cancer patients are set to be spared from weeks of back-to-back hospital visits – after studies and trials have shown that five days of treatment, or even less, can be just as effective at blasting away tumours.
People having radiotherapy, which uses powerful radiation beams to kill cancer cells, would once have had their lives turned upside down.
Daily visits to hospital, often for up to six weeks, were the norm – with work and family life put on hold.
But now – thanks to advances in technology and precision techniques – this no longer has to be the case.
Over the past two decades, UK doctors have led efforts to show that delivering bigger doses of radiation over fewer sessions can be just as successful at treating some cancer types.
And trials are repeatedly showing it to be safe, without additional side effects, despite concerns that higher doses could cause greater damage to healthy tissue.
As NHS clinics looked for ways to make treatment for cancer patients more efficient during the pandemic, many have now adopted these methods.
As a result, a growing number of NHS patients with cancer in the breast, bowel, prostate and lung are now receiving shorter – and more convenient – courses of radiotherapy.
Patients want the best treatment,’ says Dr Jeanette Dickson, President of the Royal College of Radiologists and a consultant lung oncologist.
‘But they also want minimal disruption to their lives. If four weeks is as good as six weeks, or one week as good as three weeks, they prefer the shorter option.’
In December, The Mail on Sunday reported on how specialists hoped that breast cancer could soon be beaten in a week.
And the findings of a new UK study, published this April in medical journal The Lancet, has now proved that to be the case.
There are about 55,200 new cases of breast cancer in the UK every year – and 63 per cent of patients will go on to have radiotherapy as part of their initial treatment.
Normally, women with early-stage breast cancer receive 15 doses of radiation to their tumour after surgery, delivered over three weeks.
But the FAST-Forward trial, led by a team at the Institute of Cancer Research in London, found that giving five larger daily doses over the course of one week is just as safe and effective.
It is hoped this will change standard practice in the UK – and make the treatment of breast cancer more convenient for women.
Karen Davis, 52, from Newcastle-under-Lyme, Staffordshire, was diagnosed with breast cancer in August 2013, after discovering a tiny lump in her left breast.
‘I was 45 years old and I just thought I was going to die – it was horrible,’ she says. Karen, who runs a hairdressing and beauty business, as well as a wig studio for women who lose their hair through cancer, was offered the chance to take part in the trial.
The lump, which measured 1.6cm, was surgically removed just a few weeks later.
In November 2013, she began radiotherapy and received five doses over the course of a week. ‘I think it was easier for me mentally to know that it was only five days,’ she says. ‘I used to get so nervous going into the cancer centre, my tummy would get churned up.’
The week-long course also meant she could get back to running her business sooner.
‘I thought that after my radiotherapy treatment in the morning, I’d be able to go to work, but it made me really, really tired,’ she says.
Karen has been free from cancer ever since. The only side effect she experienced was a slight numbness in parts of her breast, but this has eased over time.
‘After my radiotherapy finished I was a bit worried that I hadn’t had the three-week course,’ she says.
‘But now, I feel so lucky.’
Cancer care has been hit hard by Covid-19. According to Cancer Research UK, 12,750 people are waiting for cancer surgery, 6,000 fewer have received chemotherapy during lockdown and 2,800 fewer have had radiotherapy.
Some services were suspended as a result of staff shortages, but it was also feared treatments such as chemotherapy could make cancer patients more susceptible to the virus.
Regular hospital visits are also likely to increase the risk of exposure to it, so a shake-up of radiotherapy services could not have come at a better time.
Many NHS hospitals had already adapted so patients could continue receiving treatment in a less risky way.
Dr Dickson says: ‘The fewer visits you have to make to the oncology centre, the less chance you have of catching an infection such as Covid-19 – either from other patients, staff, or by just being out of your home.’
Shorter treatments also reduce the burden on services, and not just for breast cancer.
During the coronavirus pandemic, an international panel of experts recommended that people with some forms of bowel cancer should also have shorter radiotherapy treatment.
It followed a major study led by David Sebag-Montefiore, professor of clinical oncology at the University of Leeds, into treatments for patients with tumours in their rectum, where most bowel cancers are found.
The research, published in The Lancet in 2009, found a one-week course of radiotherapy before surgery significantly reduced the risk of the disease coming back, compared to surgery alone.
But before the pandemic patients had been given a choice between this approach, and a five-week course of chemotherapy and radiotherapy – involving up to 28 hospital trips.
‘There has not been a definitive steer in one direction or another, so both methods have been used,’ explains Prof Sebag-Montefiore.
‘But with Covid, we considered that the one-week course reduced the risks associated with travelling to hospital and being exposed to staff, and that additional chemotherapy could also potentially have a negative impact on a patient’s immune system.’
Patients with lung cancer have also seen their radiotherapy treatment shortened – from six weeks to four weeks for bigger tumours.
Three to five sessions of stereotactic ablative radiotherapy – a new, more targeted treatment, also known as SABR – would have previously been recommended to treat lung tumours smaller than one centimetre. Now, it’s just one session. Prostate cancer treatment times using SABR have also been cut from 20-30 treatments to six.
Dr Dickson is keen to stress that changes in care have only been made where there is evidence to support them.
But she admits Covid has ‘accelerated’ the adoption of these new, quicker approaches to treating cancer. And many experts hope they will be here to stay.
‘Regardless of Covid, one week of treatment versus three weeks is an advantage for the patient,’ she says.
Barbara Jacoby is an award winning blogger that has contributed her writings to multiple online publications that have touched readers worldwide.