Radiation Therapy amidst the COVID-19 Pandemic  in the Philippines: When Guidelines are Not Enough

Aveline Marie D. Ylanan; Johanna Patricia A. Cañal; Jaffar C.  Pineda; Daphne Jo S.  Valmonte

doi:10.47895/amp.vi0.3790

Aveline Marie D. Ylanan Philippine General Hospital, University of the Philippines Manila, Philippines https://orcid.org/0000-0003-0795-4221
Johanna Patricia A. Cañal Philippine General Hospital, University of the Philippines Manila, Philippines; Asian Hospital and Medical Center, Muntinlupa, Philippines https://orcid.org/0000-0001-5407-1478
Jaffar C. Pineda Jose R. Reyes Memorial Medical Center, Manila, Philippines https://orcid.org/0000-0002-2420-3799
Daphne Jo S. Valmonte Makati Medical Center, Makati, Philippines https://orcid.org/0000-0002-3741-3082

DOI: https://doi.org/10.47895/amp.vi0.3790

Keywords: radiotherapy, radiation therapy, radiation oncology, pandemic, COVID-19, ECQ, quarantine, global recommendations, guidelines implementation, radiotherapy services

Abstract

Background. To respond to the pandemic, many societies, including the American Society for Radiation Therapy
(ASTRO), the United Kingdom’s National Institute for Health and Care Excellence (NICE), and the Philippine Radiation Oncology Society (PROS), recommended guidelines to allow for continued safe delivery of oncologic services. Yet, the delivery of radiotherapy during the COVID-19 pandemic remains a challenge.

Objective. To describe the situation of radiotherapy delivery in Metro Manila (NCR) during the COVID-19-related
quarantine. Specifically, the objectives were to determine: (1) how the radiotherapy providers implemented the
recommended changes, (2) if these implemented changes allowed the hospitals to operate with pre-COVID capacities, and (3) the causative factors of treatment interruptions if these were present. Additionally, in the face of treatment interruptions, the authors sought to put forth recommendations to decrease treatment interruptions.

Methods. Investigators gathered data on the prevailing situation of RT services in their respective institutions during the strictest period of quarantine — Enhanced Community Quarantine (ECQ). Patients aged 18-70 years old who missed at least one fraction during the ECQ from March 16 – April 15, 2020, were invited to participate in a phone survey to determine factors contributing to treatment interruptions.

Results. All the institutions implemented global recommendations to adapt to the pandemic, including infection
control measures, telemedicine, and modification of RT plans. Despite this, most institutions had increased treatment interruptions during ECQ. The percentage of patients with interruptions was also much higher during the ECQ (66.37%) than during the pre-COVID month (30.56%). Among 142 patients unable to continue treatment, there were no significant differences in demographic variable and oncologic profile rates. The majority were more worried about getting COVID-19 than missing RT. The most common factor for treatment interruptions was transportation, followed by fear of getting COVID-19.

Conclusion. Compliance with global recommendations is not enough to ensure that the patients who require
radiotherapy will receive it. Based on institutional and patient results, the causative factors of interruptions included suspension of services, lack of transportation, and anxiety of patients and staff. Especially in low-resource settings, recommendations are to use available resources as efficiently as possible by having an organized referral system, providing transportation or nearby accommodation for patients and staff, and communicating effectively to reassure patients that radiotherapy can be continued safely.