Mitigating the impact of COVID-19 on oncology: Clinical and operational lessons from a prospective radiation oncology cohort tested for COVID-19

doi:10.1016/j.radonc.2020.05.037

Radiotherapy and Oncology

Volume 148, July 2020, Pages 252-257

https://doi.org/10.1016/j.radonc.2020.05.037 Get rights and content

Highlights

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Prospective cohort of 121 cancer patients tested for SARS-CoV-2 over 35 days.
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Of 7 positive cases, 6 were admitted with 4 warranting intensive care, and 2 died.
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RT was delayed in one-third of patients while awaiting RT-PCR test results.
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With a dual PPE policy, newly quarantined employees decreased 6-fold per day.
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Each patient was an exposure risk to 5 employees, most commonly RTTs (38%)

Abstract

Background and purpose

The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines.

Materials and methods

Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020–04/22/2020).

Results

A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1–4) to ≤1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75–5) to 1 business day (IQR: 1–2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3–6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2–11), with a peak of 17 employees simultaneously quarantined. Following implementation of a “dual PPE policy,” newly quarantined employees decreased from 2.9 to 0.5 per day.

Conclusion

The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.

Keywords

Pandemic

SARS-CoV-2

Acute respiratory distress syndrome

Nasopharyngeal swab

Quarantine

Isolation precautions

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^☆: The Editors of the Journal, the Publisher and the European Society for Radiotherapy and Oncology (ESTRO) cannot take responsibility for the statements or opinions expressed by the authors of these articles. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. For more information see the editorial “Radiotherapy & Oncology during the COVID-19 pandemic”, Vol. 146, 2020.

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