Prioritization of Proton Patients in the COVID-19 Pandemic: Recommendations from The New York Proton Center

Abstract

It has been well documented from the early days of the 2019 novel coronavirus (COVID-19) pandemic that patients with a diagnosis of cancer are not only at higher risks of contracting a COVID-19 infection but also at higher risks of suffering severe, and possibly fatal, outcomes from the infection. Given that the United States has the greatest number of positive coronavirus cases, it is likely that many, if not all, radiation oncology clinics will be faced with the challenge of safely balancing a patient's risk of contracting COVID-19, while under active radiation treatment, against their risk of cancer progression if treatment is delayed. To address this challenge, the New York Proton Center established an internal algorithm that considers treatment-related, tumor-related, and patient-related characteristics. Despite having suffered staff shortages due to illness, this algorithm has allowed the center to maintain patient treatment volumes while keeping the rate of COVID-19 infection low.

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…Similarly, Chhabra et al developed an internal algorithm that helped maintain patients’ treatment volume while keeping the rate of COVID-19 infection acceptable. Importantly, this algorithm considers treatment-related, tumor-related, and patient-related characteristics in order to guide the safest decision ( Chhabra et al, 2020 ).…”

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era

“…As a response to the severe COVID-19 crisis in the SAUCCC, multidimensional adjustments of radiotherapy have continuously updated to deal with the negative impact on the cancer treatment during the COVID-19 pandemic ( 10 , 17 – 19 , 23 , 24 , 28 , 34 , 42 , 43 ). The role of radiotherapy in the treatment of liver cancer has undergone a significant shift due to the pandemic ( 10 , 18 ), which is necessary for similar dilemmas in the future.…”

“…Therefore, photon and proton SABRs are the feasible alternative strategies to CIRT in the regions without CIRT resource ( 18 – 20 , 33 ). In order to achieve the above advantages of CIRT, hypofractionation regimens for photon and proton radiotherapy should be adequately utilized to shorten treatment schedules for liver cancer patients in the SAUCCC when feasible and appropriate ( 18 , 33 , 34 ). Compared with photon, proton radiotherapy has the superiority of Bragg peak that allows for the pinpoint delivery of maximum sharp energy deposition to tumors while minimizing toxicity to the surrounding noncancerous tissues and organs.…”

Proton Therapy in a Pandemic: An Operational Response to the COVID-19 Crisis

“…Experience from other centers in areas of high community spread [ 6 ] have suggested that maintaining adequate RTT staffing would be the most critical component of maintaining our ability to deliver proton therapy during the pandemic. In mid March, we developed a phased model of RTT staffing that would allow us to gradually ramp down the number of RTTs at the PTC ( Table ).…”