Regarding changes to the head-end they are
already doing those for reasons unreleated to FTTP, and even on a GPON network it's perfectly feasible to deliver the TV via RF - this is what Verizon do, complete with coax feed into the STB.
One platform for FTTx and DOCSIS
When deploying CCAP networks with access over coaxial cables, MSOs often apply FTTP methods for newly constructed areas and commercial users, such as, passive optical network (PON), RFoverlay, DPoE/DPoG, and RFoG. PON technology, with a mature industrial chain and robust bandwidth expansion capabilities, is the standard method for future FTTx. A distributed network can converge with PON where both PON and DOCSIS can be deployed on one access platform without changing the O&M process of the DOCSIS system. Therefore distributed networks have become the primary choice for carriers implementing network convergence.
Things have moved on a bit since the old CATV headends. We're not far from seeing
Remote PHY hitting the streets. Or cabinets. Whatever.
The days where signals from a CMTS and signals from the TV QAMs were simply pushed into a splitter and then sent into some optics are long gone. The CMTS and TV multiplexers output UDP over Ethernet via fibre into switches which feed Edge QAMs so none of it goes RF until the last minute.
TL;DR the modern headend is pretty modular and, largely, delivery platform agnostic.