Changes to bowel cancer treatments during the coronavirus pandemic
Page updated: Thursday 25 March 2021
The NHS is focused on recovering cancer services that have been set back by the coronavirus pandemic. They're working hard to ensure bowel cancer diagnosis, treatment and care continues, and eventually return to operating as they did before COVID-19.
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:
1. Reduces the need for people to attend hospital to receive medication
2. Minimises treatment side effects that might make patients more likely to be admitted to hospital
3. 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're 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'll let you know when they're ready for you to see them.
- You may be asked to self-isolate for seven days before any diagnostic procedures, even if you do not have coronavirus symptoms.
- COVID-19 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-19 patients to ensure that COVID-19 and non-COVID patients are kept separate. For example, there may be separate entrances for COVID and non-COVID-19 patients, all patients admitted to hospital as an emergency will be tested for COVID-19, and patients going into hospital for surgery or another elective procedure will be asked to isolate for 14 days and be offered a COVID-19 test wherever possible.
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.
- If you’re having other treatments to help keep your bones strong (such as denosumab) this might be temporarily stopped.
- You might be able to have your treatment at home if it's available in a tablet form.
- You might be given additional treatment alongside your normal treatment to help promote your blood cells to grow and boost your immune system. This extra treatment is known as GSCF (granulocyte-colony stimulating factor).
- Your clinical team might suggest you take a treatment break when risk of coronavirus is high.
- 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'll 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 1 July 2021. In July, there were will be another review to see if these interim treatments need to be in place for longer.
NICE guidance recommends that for some bowel cancer patients the following options may be available, but it can depend on the individual. Speak to your healthcare team to find out if these changes affect you:
- You 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 systemfrom working as effectively as usual. 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.
- People with newly diagnosed bowel cancer that has spread to another part of the body, who are either MSI high and/or have deficient mismatch repair genes, will now be able to take a drug called nivolumab or pembrolizumab instead of chemotherapy.
- Nivolumab and pembrolizumab are immunotherapy drugs that help your immune system find and kill cancer cells.
- They're not yet approved by NICE for bowel cancer (it is currently under review) but is approved for other cancers.
Using nivolumab or pembrolizumab rather than chemotherapy will hopefully reduce the number of hospital appointments people need, and reduce the chances of people developing neutropenia, which makes them much more susceptible to infections.
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'll still have funding for treatment.
The suspension of the treatment break rules will apply until at least 1 July 2021. In July, there were will be another review to see if this suspension needs to be in place for longer.
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.
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'll 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'll help them decide which operations will go ahead as planned and which ones might need to be delayed. They'll use the following groups to help them make these decisions if required. Priority level one is seen as the most urgent and level three is the least urgent.
- an obstruction (or blockage)
- if your disease has progressed and is causing you injury or harm (for example if there's a lot of pressure on your spinal cord, known as spinal cord compression).
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'll use the following groups to help them make these decisions if required. Priority level one is seen as the most urgent and level six is the least urgent.
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'll use the following groups to help them make these decisions if required. Priority level one is seen as the most urgent and level five is the least urgent.