GSOR04 Presentation Time: 5:15 PM

Purpose

Cervical cancer remains the most prevalent cancer treated in Botswana. With only a single institution offering curative chemoradiation during the pandemic, brachytherapy cases serve as a proxy for all curative interventions.The study examines the consequences of the COVID-19 pandemic on the provision of brachytherapy for cervical cancer in Botswana, emphasizing the challenges posed by lockdowns and restrictions on both local and international travel. The impact of the COVID-19 pandemic on the continuity of brachytherapy could mirror disruptions faced by other cancer treatments due to regional lockdowns and centralized treatment modalities.

Materials and Methods

A longitudinal analysis of brachytherapy cases from 2018 to 2023 was conducted, with a particular focus on the trend changes coinciding with the COVID-19 pandemic. Data was collated from hospital records, maintenance logs for medical equipment, national cancer registries, and pandemic response documentation. The analysis explored the correlation between pandemic-related restrictions and the accessibility of brachytherapy services.

Results

Of the 2499 brachytherapy insertions done in the six years between 2018 and 2023 only 110 insertions (4.5%) were done in 2020 and 238 (9.5%) in 2021, the peak COVID years. Fig 1 illustrates the pandemic's impact on brachytherapy services in Botswana.The one-way ANOVA conducted to compare the mean number of brachytherapy insertions before(2018 to 2019), during (2020 to 2021), and after (2022 to 2023) the pandemic yields an F-statistic of approximately 33.837 and a p-value of approximately 0.0087, suggesting that there is a statistically significant difference in the number of brachytherapy insertions among at least two of the three periods compared. The analysis highlights a severe reduction in brachytherapy treatments in 2020 and 2021. This period coincides with a gorvenrment lockdown beginning in April 2020, with subsequent regional lockdowns and quarantine of both healthcare workers and patients. There was a three-month breakdown of the single linear accelerator at the nation's primary cancer treatment center, attributable to the absence of engineers from South Africa who were unable to travel due to lockdowns. Additionally, the expiry of the Ir192 source, essential for brachytherapy and challenging to replace due to its short half-life of 174 days, led to a six-month cessation of services. This was compounded by regulatory complexities and the dependence on international engineers for both source replacement and equipment servicing.

Conclusion

The COVID-19 pandemic significantly disrupted brachytherapy services for cervical cancer, reflective of broader oncological treatment challenges during this period. It exposed vulnerabilities in Botswana's cancer treatment infrastructure, particularly the risk associated with using a short-lived isotope like Ir192 in a country dependent on international support. The situation advocates for the consideration of longer-half-life sources such as Cobalt 60, which could offer more resilience for healthcare systems in similar contexts. However, the recovery trajectory post-2021 highlights the healthcare system's adaptability and the critical importance of maintaining cancer treatment services during global crises. Future strategies should focus on resilient healthcare structures to withstand similar disruptions, ensuring uninterrupted cancer care.