Running of high patient volume radiation oncology department during COVID-19 crisis in India: our institutional strategy

Abstract

Coronaviruses are enveloped, single-stranded, positive-strand RNA viruses and are classified under Nidovirales. The 2019-novel coronavirus (2019-nCoV) is classified as a novel betacoronavirus belonging to the sarbecovirus subgenus of Coronaviridae family [1-3]. The 2019-nCoV is the third coronavirus to exhibit cross species infection from animals to humans. The previous two being 2002 outbreak caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the 2012 outbreak caused by the Middle East respiratory syndrome coronavirus (MERS-CoV) [4,5]. Coronaviruses are known to cause common colds in human adults and children. It typically causes common cold like symptoms in immunocompetent individuals. Coronavirus disease 2019 (COVID-19) has a unique pathogenicity with its ability to cause both upper as well as lower respiratory tract infection Purpose: Due to COVID 19 pandemic, the treatment of cancer patients has become a dilemma for every oncologist. Cancer patients are at an increased risk of immunosuppression and have a higher risk to acquire any infection. There are individual experiences from some centers regarding the management of cancer patients during such a crisis. So we have developed our institutional strategy to balance between COVID and cancer management. Materials and Methods: Radiation Oncology departmental meeting was held to prepare a consensus document on Radiotherapy schedules and department functioning during this pandemic. Results: Strategies were taken in form of following areas were steps need to be taken to decrease risk of infection, categorise treatment on the basis of priority, radiotherapy schedules modification, academic meetings and management of COVID positive patient/personnel in Radiation Oncology department. Conclusion: We hope to strike the balance in overcoming both the battles and emerge as winners. Stringent long term follow up will be done for assessing the response or any unforeseen treatment related sequelae.

Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

“…Five studies reported providing staff with initial and ongoing education and training on correct use, maintenance and disposal of PPE, hand hygiene, disinfection procedures, isolation policies, symptoms of COVID-19 and latest national guidelines on diagnosing and managing COVID-19 (Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Wei et al 2020;Wu et al 2020). Strategies frequently mentioned for delivering training included educational pamphlets and a blend of web-based learning and hands-on experience (Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Wei et al 2020). In the early phase of the pandemic, lack of effective infection control programmes and weak enforcement mechanisms were major factors associated with increased person-to-person transmission resulting in several radiation oncologists, two radiation therapists and an unknown number of patients been infected with COVID-19 (Wu et al 2020).…”

“…gowns, masks, face shields and gloves) (Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020), keeping treatment and other rooms well-ventilated Wei et al 2020;Xie et al 2020), disinfecting surfaces that patients and staff are in constant contact with, such as treatment couch (Motlagh et al 2020;Samiee et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020), adhering to strict hand hygiene (Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Samiee et al 2020;Wei et al 2020;Xie et al 2020) and managing waste effectively Wei et al 2020;Xie et al 2020) were approaches frequently reported for creating safe infection control practice. Four studies reported cancer patients and their accompanying carers were required to wear face masks when entering the radiotherapy facility to protect themselves in a preventive manner (Gupta et al 2020;Motlagh et al 2020;Samiee et al 2020;Wei et al 2020). Shortages of face masks in the community was a critical barrier.…”

“…All studies highlighted the importance of adopting triage systems to sort, assess and prioritise staff, cancer patients and their carers entering the radiotherapy centre (Aghili, Jafari & Vand Rajabpoor 2020;Baldotto et al 2020b;Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Saab et al 2020;Samiee et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020). From these studies designing a ow chart helped facilitate the COVID-19 screening and testing process (Samiee et al 2020;Xie et al 2020).…”

“…Daily body temperature check at the entrance and asking cancer patients and their carers series of questions were critical to identifying if they present symptoms indicative of COVID-19. Moreover, further studies showed that most radiotherapy centres in LMICs had implemented suspect case testing for staff, cancer patients and carers who have had close contact with a COVID-19 case and/or have symptoms of COVID-19 (Aghili, Jafari & Vand Rajabpoor 2020;Gupta et al 2020;Motlagh et al 2020;Saab et al 2020;Samiee et al 2020;Wei et al 2020;Xie et al 2020). Overall, a suspect case testing included chest computed tomography (CT) scan and polymerase chain reaction (PCR) test (Aghili, Jafari & Vand Rajabpoor 2020;Saab et al 2020;Xie et al 2020).…”

“…Other studies were conducted in Iran (Aghili, Jafari & Vand Rajabpoor 2020;Motlagh et al 2020;Samiee et al 2020), Brazil (Baldotto et al 2020b) and Zambia (Lombe et al 2020). Ten of the included studies employed a qualitative design (Aghili, Jafari & Vand Rajabpoor 2020;Baldotto et al 2020b;Gupta et al 2020;Lombe et al 2020;Motlagh et al 2020;Samiee et al 2020;Wei et al 2020;Wu et al 2020;Xie et al 2020). A variety of methods were used including case reports (Lombe et al 2020;Samiee et al 2020;Wei et al 2020;Xie et al 2020), experts consensus (Aghili, Jafari & Vand Rajabpoor 2020;Baldotto et al 2020b;Gupta et al 2020;Motlagh et al 2020), cross-sectional survey (Saab et al 2020) and critical review (Wu et al 2020).…”