Changes to bowel cancer treatments during the coronavirus pandemic
Page updated: Tuesday 14 December
The NHS is focusing on making sure that care for patients continues to be safe, effective and holistic. This means that cancer diagnosis, treatment and care are continuing, and the NHS is working to ensure that these services return to operating as they did before. However, some services may be delivered in a slightly different way. This is for patient safety by using infection control measures to reduce the spread of COVID-19 and to help keep other services running.
We understand that for some people treatment has changed, been delayed or cancelled. This section covers changes to bowel cancer treatments and answers some frequently asked questions.
The National Institute of Care and Health Excellence (NICE) is a public body that produces guidance for healthcare professionals. During the coronavirus pandemic, they have produced guidance for temporary changes and interim treatments for bowel cancer. These are either changes to the way drugs are normally given for bowel cancer, or new drugs that are not yet approved by NICE that have been granted temporary permission to be used during the pandemic.
The reasons for these temporary changes are to help healthcare professionals to continue to treat bowel cancer patients in a way that:
- Reduces the need for people to attend hospital to receive medication
- Minimises treatment side effects that might make patients more likely to be admitted to hospital
- Provide additional treatment options to patients that are less likely to suppress their immune system, which leaves people at greater risk of developing infections, such as COVID-19.
Some of the wider changes to care are listed below:
- You are likely to have more consultations via telephone or video where possible. This is to help people avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.
- You may be asked not to arrive for your appointment early. Some hospitals may ask you to wait in your car and they will let you know when they’re ready for you to see them
- You may be asked to attend appointments without family members or carers
- COVID-protected hubs have been set up across the country to ensure that cancer treatment continues. These hubs support hospitals across the NHS and independent sector to work together to maximise capacity and ensure that people receive the treatment that they need. Some patients may start to see their treatment move to a different hospital as these hubs are set up. You’ll remain under the care of your treating hospital and clinical specialist team and should contact them with any questions about your treatment and care.
- Other measures are also being taken by all hospitals that are treating COVID patients to ensure that COVID and non-COVID patients are kept separate. For example, there may be separate entrances for COVID and non-COVID patients, all patients admitted to hospital as an emergency will be tested for COVID, and patients going into hospital for surgery or another elective procedure may be asked to isolate for 14 days and be offered a COVID test wherever possible. Your hospital will have specific guidelines about what to do before appointments. Follow the advice from your hospital.
There may be changes to how you receive treatment. Some of these are listed below:
- Depending on what drug you are having, you might be able to take your treatment in a different way. For example, if you usually have a drip or infusion, it might be possible to have a tablet version of your medicine if this is available.
- You might be able to have your treatment over a shorter length of time or the time between your treatment cycles might change. For example, if you usually have treatment every two weeks, this might change to every four or six weeks.
- If you usually have your treatment in a tablet form, you might be given a larger supply of your medicine to keep you going for a longer period.
- You might be able to have your treatment at home if it’s available in a tablet form.
- Your clinical team might suggest you take a treatment break. This could be longer than six weeks..
- Some of your usual appointments and check-ups might change. For example, you might have blood tests locally or have more appointments over the phone or via video.
Your clinical team are best placed to talk with you about your treatment and appointments. They will work with you to work out the best course of action in each individual situation. If you have any concerns or questions about your treatment, please speak to your clinical team.
If you begin an interim treatment during the COVID-19 pandemic you will be allowed to continue taking this treatment until you and your clinician decide together that it's time to stop, or to switch to a different treatment. This guidance will remain until at least 31 March 2022. In December there were will be another review to see if these interim treatments need to be in place for longer.
NICE guidance recommends that some bowel cancer patients may be able to have intermittent treatment with chemotherapy that contain the drugs cetuximab or panitumumab. This is to help reduce the need for treatments that reduce the body's immune system from working as effectively as usual.
This means that you will be able to take breaks between cycles of treatment with these drugs.
During the coronavirus pandemic, the current treatment break policy, which applies to both Cancer Drugs Fund (CDF) and non-CDF treatments, will not be applied. This means that you are allowed to take a treatment break for longer than six weeks, if you and your healthcare team decide that this is best option for you. If you do take a treatment break, you will still have funding for treatment.
The suspension of the treatment break rule will apply until at least 31 March 2022. In December, there were will be another review to see if this suspension needs to be in place for longer. Read more about treatment breaks and what we have been doing in our blog.
If you and your healthcare team decide to start and stop treatment, you will still be able to access the treatments again after a significant break.
Speak to your healthcare team to find out if this change affects you.
If you have concerns about your clinical trial, or if your trial has been stopped, you should contact your clinical team with questions about your individual treatment.
The National Institute for Health Research (NIHR) issued guidance earlier during the pandemic response which recognised that much research would need to pause, not least because many clinical research teams were asked to redeploy to help with providing patient care. The NIHR has now published a framework to support work towards the restoration of research that they fund and/or support. Their COVID-19 response can be found on the NIHR website.
Clinicians will always make decisions to prioritise treatment for those most in need and in consultation with patients.
Many hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.
Your clinical team are best placed to talk with you about the effect on your treatment and appointments. They will work with you to determine the best course of action in each individual situation. If you have any concerns or questions about your treatment, please speak to your clinical team.
Will my surgery be delayed?
At the moment, the coronavirus pandemic doesn’t mean that everyone will experience delays to their surgery. If any surgery does need to be delayed, clinicians will look at how urgently each patient needs to have surgery. This will help them decide which operations will go ahead as planned and which ones might need to be delayed. They will use the following groups to help them make these decisions if required. Priority level 1 is seen as the most urgent and level 3 is the least urgent.
Priority level 1a
An emergency operation is needed within 24 hours to save life.
Priority level 1b
An urgent operation is needed within 72 hours. Surgery falling into groups 1a and 1b include things like:
- an obstruction (or blockage)
- if your disease has progressed and is causing you injury or harm (for example if there is a lot of pressure on your spinal cord, known as spinal cord compression)
Priority level 2
A non-urgent operation is needed to try and cure your cancer or stop the disease progressing within four weeks. How quickly you have surgery will depend on the severity of any symptoms or complications you’re having and how quickly your cancer is likely to grow.
If your operation falls under this category, you might be able to have other types of treatment whilst you’re waiting for surgery (for example, you may be able to have a colonic stent).
Priority level 3
A non-urgent operation that can be delayed for 10 to 12 weeks.
Can I still have chemotherapy, targeted or immunotherapy?
At the moment the coronavirus pandemic doesn’t mean that everyone will experience delays to their treatment. If any treatment needs to be delayed, clinicians will look at how urgently each patient needs to have treatment. They will use the following groups to help them make these decisions if required. Priority level 1 is seen as the most urgent and level 6 is the least urgent.
Priority level 1
Treatment aims to cure the cancer and is likely to have a high chance of success. It is likely to significantly increase the chance of success when given alongside other treatment, such as surgery.
Priority level 2
Treatment aims to cure the cancer and is likely have a moderate chance of success. It’s likely to offer a moderate chance of curing the cancer when given alongside other treatment, such as surgery.
Priority level 3
Treatment aims to cure the cancer but has a low chance of success. It is likely to offer a low chance of curing the cancer when given alongside other treatment, such as surgery. The treatment aims to prolong life, rather than cure the cancer. There is a high chance that the treatment could extend life by more than one year.
Priority level 4
Treatment aims to cure the cancer but has a very low chance of success. This includes additional treatment offered alongside, such as surgery. Treatment aims to prolong life, rather than cure the cancer. There is a moderate chance that the treatment could extend life by more than one year.
Priority level 5
There’s a high chance that the treatment could help control symptoms and improve quality of life, but is not likely to extend life by more than one year.
Priority level 6
There’s a moderate chance that the treatment could help control symptoms and improve quality of life, but is not likely to extend life by more than one year
Will my radiotherapy treatment be delayed?
At the moment the coronavirus pandemic doesn’t mean that everyone will experience delays to their radiotherapy treatment. If any treatment needs to be delayed, clinicians will look at how urgently each patient needs to have treatment. They will use the following groups to help them make these decisions if required. Priority level 1 is seen as the most urgent and level 5 is the least urgent.
Priority level 1
High doses of radiotherapy (or a combination of chemotherapy and radiotherapy) is already being used to try and cure a fast growing cancer and there is no allowance for gaps between treatment.
Radiotherapy is already being delivered from outside the body (external beam radiotherapy) and radiotherapy from inside the body (brachytherapy) is planned afterwards to treat a fast growing cancer.
If radiotherapy hasn’t started yet, it may still go ahead if there is an urgent need to start it in line with current cancer waiting times.
Priority level 2
Radiotherapy is being used to treat patients whose cancer is putting pressure on their spinal cord (spinal cord compression).
Priority level 3
High doses of radiotherapy are being used as a first treatment to try and cure a less aggressive cancer. Radiotherapy is being given after surgery to try and destroy any cancer that still remains.
Priority level 4
Radiotherapy is being used to try and treat symptoms, improve quality of life or slow down growth of the cancer.
Priority level 5
Radiotherapy is being given after surgery and there is a low risk that the cancer will come back within 10 years.