Covid-19 & Radiotherapy

What is coronavirus disease (Covid-19)?

It is a flu-like virus, which can affect your lungs and airways and is characterised by fever and a cough. It is caused by a newly discovered coronavirus. Coronaviruses are a large family of viruses, and the term Covid-19 is the disease caused by the new coronavirus that emerged in December 2019.

With the UK removing restrictions we understand this can be an unsettling time for people with a cancer diagnosis receiving treatments that may compromise the immune system. It can be difficult to know how to best navigate your everyday life to minimise the risk of infection and stay safe. We have compiled a list of frequently asked questions and top tips we hope will help.

What are the most common symptoms?

Symptoms of coronavirus (COVID-19) in adults can include:

• an elevated temperature or shivering (chills) – an elevated temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• a new, continuous cough – this means coughing for more than an hour, or three or more coughing episodes in 24 hours
• a loss or change to your sense of smell or taste
• shortness of breath
• feeling tired or exhausted
• an aching body
• a headache
• a sore throat
• a blocked or runny nose
• loss of appetite
• diarrhoea
• feeling sick or being sick

The symptoms are very similar to symptoms of other illnesses, such as colds and flu.

What do I do if I have symptoms?

The NHS is offering antibody and antiviral treatments to people with COVID-19 who are at highest risk of becoming seriously ill or have severely weakened immune systems.

If you have had certain types of chemotherapy in the last 12 months or radiotherapy in the last 6 months, you are considered to be high risk and are therefore eligible to access these treatments.

If you have symptoms make sure you have some rapid lateral flow tests at home so you can get tested quickly if you get symptoms of COVID-19.

If you do not have tests at home or need more tests, you can order free COVID-19 rapid lateral flow test kits on GOV.UK. You must use lateral flow tests supplied by the government. The results of tests bought privately, such as from a supermarket or pharmacy, cannot currently be registered on GOV.UK and you will not be contacted about treatment if you test positive using these tests.

If you cannot order tests online, you can call 119 free of charge.

If you have COVID-19 symptoms you should take a lateral flow test immediately, even if your symptoms are mild. You must report your result on GOV.UK or by calling 119. It is important to provide your NHS number and postcode correctly so you can be contacted. If your test is negative but you still have symptoms, you should take another test on each of the next 2 days (3 tests in total over 3 days).

What to do if you test positive.

Even if you are testing positive it is likely you may still be able to continue your radiotherapy treatment. This will depend on your symptoms and whether the risks of giving radiotherapy outweigh the benefits. It may be necessary to interrupt your radiotherapy to allow time for you to recover if you are unwell.

It is important you contact your oncology team, acute oncology service, chemotherapy helpline or radiotherapy review team as soon as possible. You will be assessed over the phone, and they will advise you on next steps regarding your treatment as each case is individual.

You must report your COVID-19 rapid lateral flow test result on GOV.UK.

If you cannot report your test result online, you can call 119 free of charge.

You need to report your test result so the NHS can contact you about treatment if your result is positive. It is important to start any treatment if required as soon as you can. Treatments for COVID-19 need to be given quickly after your symptoms start to be effective.

If you have reported your positive test result, the NHS will usually call you within 24 hours of your result.

They will give you more information and ask questions to check if treatment is right for you.

They may ask what other medicines you take or receive, including any vitamins and minerals, so it is important to have a list of these ready.

Do not go to a GP surgery, pharmacy, or hospital. Stay at home until you have spoken to your oncology team, acute oncology service, chemotherapy helpline or radiotherapy review team.

Go to 111.nhs.uk or call 111 to check your symptoms. If you become seriously ill, call 999.

For more information on testing positive and what you should do please visit the NHS website here Treatments for coronavirus (COVID-19) – NHS (www.nhs.uk) which has all the most up to date information.

What do I do if someone I live with has symptoms or has tested positive?

• avoid contact with the person who has COVID-19 as much as you can
• wear a face covering that fits snugly against your face and has more than one layer where you are in close contact with them
• wash your hands often with soap or water, or use hand sanitizer
• spend as little time as possible in spaces you share with the other people in your household (such as living rooms and kitchens)
• keep windows open for at least 10 minutes after any infected persons have left the room to let in fresh air.
• regularly clean surfaces touched often (such as door handles and remote controls) and in shared spaces, such as kitchens or bathrooms.

Contact your oncology team, acute oncology service, chemotherapy helpline or radiotherapy review team as soon as possible.

You could be an asymptomatic carrier or a transmission risk and this may affect when you can attend for radiotherapy.

Go to 111.nhs.uk or call 111 to check their symptoms. If they become seriously ill, call 999

Is it okay to have my radiotherapy treatment?

Yes.

Your radiotherapy team will speak to you if there are any changes to your radiotherapy treatment plan. They will only stop your treatment or give you a treatment break if it is safe to do so. If you are given a treatment break, every effort will be made to ensure you complete your treatment. Please be reassured that nothing will be altered without first consulting you.

I have had radiotherapy in the past: am I at risk of becoming seriously ill from Covid-19?

If you have had radiotherapy in the last 6 months, you are considered to be at a higher risk of becoming seriously ill with coronavirus. Also, if you have received certain chemotherapy drugs in the last 12 months this can also mean you are at a higher risk of becoming ill. It is important therefore to take necessary precautions – see section on keeping yourself safe. If you are at all concerned, contact your oncology team, acute oncology service, chemotherapy helpline or radiotherapy review team.

What should I expect when I come to the radiotherapy department if I have COVID?

All departments will run slightly differently so there is not a one size fits all answer to this but below are some likely scenarios.

It is likely some departments will treat you at the end of the day when there are less patients in the department and therefore less infection risks. This may be very problematic if you require hospital transport so could require a lot of waiting around.

Another possibility is there will be a treatment machine that focuses on those patients that have tested positive, you may therefore receive your treatment in a different room than you have previously. Be assured your treatment will be the same but the machines can look and sound slightly different, this is completely normal.You may be asked to sit in a different waiting area from previous appointments to minimise your contact with uninfected patients.

The therapeutic radiographers treating you will wear full personal protective equipment, (masks, glasses, gowns, gloves) to protect themselves and you from cross infection. This is for everyone’s safety and to help reduce the spread of Covid-19. It is not currently necessary for you to wear PPE, but if you have a cough, you may be asked to wear a mask.

Why has my treatment been changed/postponed?

Having radiotherapy requires you to come into hospital every day which could increase your risk of catching and/or spreading Covid-19. It is possible in some cases to reduce this risk by giving radiotherapy in fewer visits or even postponing radiotherapy where the cancer is low risk and can be monitored. These changes to treatment are considered on a case-by-case basis and are based on high-quality evidence. Your oncologist will weigh up the risks and benefits of you having radiotherapy treatment and discuss these with you.

Healthcare teams will also consider the impact of Covid-19 on your local health services. This may mean some treatments will be prioritised over others, where it is safe to do so. This is in line with NHS guidance. National guidelines on Covid-19 and local guidelines at your hospital are being reviewed regularly. Your radiotherapy team will let you know of any changes that may apply to you or your treatment.

What if I feel unwell during my radiotherapy treatment?

If you feel unwell or if you have any side effects during radiotherapy, please make sure to tell your radiotherapy team. Please do not withhold any symptoms or side effects. It is important to share how you are feeling so that you can receive the correct care and support throughout your treatment.

Keeping yourself safe

• ensure you have had all the vaccines you are eligible to receive
• continue to follow any condition-specific advice you have been given by your cancer specialist

We recommend that you avoid meeting with someone who has tested positive for COVID-19 (and anyone in their household) until 10 days after they received a positive test. Try to avoid people who have symptoms of COVID-19 or other respiratory infections and have a temperature or feel unwell.

If you have visitors to your home, ventilate your home by opening windows and doors to let fresh air in and consider asking visitors to exercise precautionary behaviors such as keeping their distance. Tests are no longer free for the general public, but you can ask visitors to take a rapid lateral flow test before visiting if you wish. You might also consider asking them to wear a face covering and want to wear a face covering yourself.

If it feels right for you, work from home if you can. If you cannot work from home, speak to your employer about what arrangements they can make to reduce your risk. It may be that you are entitled to a Reasonable Adjustment under the Equality Act. See Public health principles for reducing the spread of COVID-19 and other respiratory infections in the workplace.

If you are too ill to work, you may be eligible for Statutory Sick Pay.

Exercising is important to remain well so consider outdoor activities rather than visiting a gym or attending classes.

When out and about, keep social distancing if that feels right for you, and consider reducing the time you spend in enclosed crowded spaces. Wash your hands regularly and avoid touching your face.

Consider continuing to wear a face covering in crowded public spaces. Although face coverings are primarily worn to protect others, because they cover the nose and mouth, which are the main sources of emission of the virus that causes COVID-19 infection, they can also provide some limited protection to the wearer.

Getting support

If you are feeling scared or overwhelmed by any of this, please do speak to a member of your radiotherapy team. They are here to help and support you. You can also email Radiotherapy UK on info@radiotherapy.org.uk if you have any concerns, comments or suggestions about this information.