1
|
Fujita M, Nagashima K, Uno T, Hashimoto H, Suzuki K, Kasai T, Yamaguchi K, Onouchi Y, Sato D, Fujisawa T, Hata A. Impact of the COVID-19 Pandemic on Hypofractionated Radiation Therapy Use for Breast Cancer in Japan: A Nationwide Study. Adv Radiat Oncol 2024; 9:101555. [PMID: 39104876 PMCID: PMC11298581 DOI: 10.1016/j.adro.2024.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 08/07/2024] Open
Abstract
Purpose Hypofractionated radiation therapy (RT) was recommended for several cancer sites to reduce outpatient visits during the COVID-19 pandemic. This study aimed to identify the impact of the pandemic on hypofractionated RT for breast cancer in Japan. Methods and Materials The monthly number of courses for hypofractionated and conventional RTs was counted using sample data sets from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, a nationwide database accumulating insurance claims data comprehensively. Changes in the number of hypofractionated and conventional RTs were estimated using an interrupted time-series analysis. Results The number of hypofractionated RT courses gradually increased before the pandemic in contrast to that of conventional RT courses, which gradually decreased. However, conventional RT remained outnumbered by hypofractionated RT throughout the observation period. After the outbreak of the pandemic, the use of hypofractionated RT significantly increased in April 2020 (1312 courses; 95% CI, 801-1823) but decreased in October 2020 (-601; 95% CI, -1111 to -92). Subgroup analysis by age and the number of beds in medical institutions revealed similar trends. Conclusions Although conventional RT for breast cancer has been gradually replaced by hypofractionated RT, it remains predominant. The use of hypofractionated RT increased briefly early in the COVID-19 pandemic; however, this increase was not sustained, unlike in other countries. Considering the benefits of hypofractionated RT for breast cancer, its use should be encouraged in Japan.
Collapse
Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Hideyuki Hashimoto
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| | - Kiminori Suzuki
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| | - Kazuya Yamaguchi
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan
| | - Daisuke Sato
- Hospital and Health Administration, Fujita Health University Graduate School of Medicine, 1-98 Dengakugakubo, Kutukake-cho, Toyoake, Aichi, Japan
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-ku, Chiba, Japan
| |
Collapse
|
2
|
Roumeliotis M, Thind K, Morrison H, Burke B, Martell K, van Dyke L, Barbera L, Quirk S. The impact of advancing the standard of care in radiotherapy on operational treatment resources. J Appl Clin Med Phys 2024; 25:e14363. [PMID: 38634814 PMCID: PMC11244663 DOI: 10.1002/acm2.14363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To demonstrate the impact of implementing hypofractionated prescription regimens and advanced treatment techniques on institutional operational hours and radiotherapy personnel resources in a multi-institutional setting. The study may be used to describe the impact of advancing the standard of care with modern radiotherapy techniques on patient and staff resources. METHODS This study uses radiation therapy data extracted from the radiotherapy information system from two tertiary care, university-affiliated cancer centers from 2012 to 2021. Across all patients in the analysis, the average fraction number for curative and palliative patients was reported each year in the decade. Also, the institutional operational treatment hours are reported for both centers. A sub-analysis for curative intent breast and lung radiotherapy patients was performed to contextualize the impact of changes to imaging, motion management, and treatment technique. RESULTS From 2012 to 2021, Center 1 had 42 214 patient plans and Center 2 had 43 252 patient plans included in the analysis. Averaged over both centers across the decade, the average fraction number per patient decreased from 6.9 to 5.2 (25%) and 21.8 to 17.2 (21%) for palliative and curative patients, respectively. The operational treatment hours for both institutions increased from 8 h 15 min to 9 h 45 min (18%), despite a patient population increase of 45%. CONCLUSION The clinical implementation of hypofractionated treatment regimens has successfully reduced the radiotherapy workload and operational treatment hours required to treat patients. This analysis describes the impact of changes to the standard of care on institutional resources.
Collapse
Affiliation(s)
- Michael Roumeliotis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kundan Thind
- Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Hali Morrison
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Ben Burke
- University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Sarah Quirk
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Penrod D, Hirsch B. Nursing Care for Metastatic Bone Cancer: Trends for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6483. [PMID: 37569024 PMCID: PMC10418383 DOI: 10.3390/ijerph20156483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
To effectively treat patients and minimize viral exposure, oncology nurses and radiology departments during COVID-19 had to re-examine the ability to offer palliative radiation treatments to people with metastatic bone cancer. Decreasing potential exposure to the virus resulted in extra measures to keep patients and personnel safe. Limiting radiotherapy treatments, social distancing, and limiting caregivers were a few of the ways that oncology patients were impacted by the pandemic. Hypofractionated radiation therapy (HFRT), or the delivery of fewer higher-dose treatments, was a method of providing care but also limiting exposure to infection for immunocompromised patients as well as healthcare staff. As oncology radiation centers measure the impact of patient care during the pandemic, a trend toward HFRT may occur in treating the painful symptoms of bone cancer. In anticipation that HFRT may be increasingly used in patient treatment plans, oncology nurses should consider patient perspectives and outcomes from the pandemic to further determine how to manage future trends in giving personalized care, and supportive care.
Collapse
Affiliation(s)
- Debra Penrod
- Nursing, School of Health Sciences, Southern Illinois University, Carbondale, IL 62901, USA
| | - Brandon Hirsch
- Radiological Sciences, School of Health Sciences, Southern Illinois University, Carbondale, IL 62920, USA;
| |
Collapse
|
4
|
Oladeru OT, Dunn SA, Li J, Coles CE, Yamauchi C, Chang JS, Cheng SHC, Kaidar-Person O, Meattini I, Ramiah D, Kirby A, Hijal T, Marta GN, Poortmans P, Isern-Verdum J, Zissiadis Y, Offersen BV, Refaat T, Elsayad K, Hijazi H, Dengina N, Belkacemi Y, Luo FD, Lu S, Griffin C, Collins M, Ryan P, Larios D, Warren LE, Punglia RS, Wong JS, Spiegel DY, Jagsi R, Taghian A, Bellon JR, Ho AY. Looking Back: International Practice Patterns in Breast Radiation Oncology From a Case-Based Survey Across 54 Countries During the First Surge of the COVID-19 Pandemic. JCO Glob Oncol 2023; 9:e2300010. [PMID: 37471670 PMCID: PMC10581620 DOI: 10.1200/go.23.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has profoundly affected cancer care worldwide, including radiation therapy (RT) for breast cancer (BC), because of risk-based resource allocation. We report the evolution of international breast RT practices during the beginning of the pandemic, focusing on differences in treatment recommendations between countries. MATERIALS AND METHODS Between July and November 2020, a 58-question survey was distributed to radiation oncologists (ROs) through international professional societies. Changes in RT decision making during the first surge of the pandemic were evaluated across six hypothetical scenarios, including the management of ductal carcinoma in situ (DCIS), early-stage, locally advanced, and metastatic BC. The significance of changes in responses before and during the pandemic was examined using chi-square and McNemar-Bowker tests. RESULTS One thousand one hundred three ROs from 54 countries completed the survey. Incomplete responses (254) were excluded from the analysis. Most respondents were from the United States (285), Japan (117), Italy (63), Canada (58), and Brazil (56). Twenty-one percent (230) of respondents reported treating at least one patient with BC who was COVID-19-positive. Approximately 60% of respondents reported no change in treatment recommendation during the pandemic, except for patients with metastatic disease, for which 57.7% (636/1,103; P < .0005) changed their palliative practice. Among respondents who noted a change in their recommendation during the first surge of the pandemic, omitting, delaying, and adopting short-course RT were the most frequent changes, with most transitioning to moderate hypofractionation for DCIS and early-stage BC. CONCLUSION Early in the COVID-19 pandemic, significant changes in global RT practice patterns for BC were introduced. The impact of published results from the FAST FORWARD trial supporting ultrahypofractionation likely confounded the interpretation of the pandemic's independent influence on RT delivery.
Collapse
Affiliation(s)
| | - Samantha A. Dunn
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Jian Li
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Charlotte E. Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Shiga, Japan
- The Corona Countermeasures Executing Group of the Japanese Society for Radiation Oncology, Japan
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, South Korea
| | - Skye Hung-Chun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Orit Kaidar-Person
- Department of Radiation Oncology, Sheba Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- GROW-School for Oncology and Developmental Biology or GROW (Maastro), Maastricht University, Maastricht, The Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences “M. Serio,” University of Florence, Florence, Italy
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk Antwerp, Belgium
| | - Josep Isern-Verdum
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Tamer Refaat
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Hussam Hijazi
- Department of Radiation Oncology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Natalia Dengina
- Department of Radiotherapy, Ulyanovsk Regional Cancer Center, Ulyanovsk Oblast, Russia
| | - Yazid Belkacemi
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM 955 i-Biot Unit, University of Paris-Est (UPEC), Creteil, France
| | - Feng Deng Luo
- Department of Radiation Oncology and Henri Mondor Breast Center, INSERM 955 i-Biot Unit, University of Paris-Est (UPEC), Creteil, France
| | - Shun Lu
- Department of Radiation Oncology Center, Sichuan Cancer Center, Chengdu, China
| | - Colleen Griffin
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Maya Collins
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Phoebe Ryan
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Dalia Larios
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Laura E. Warren
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Rinaa S. Punglia
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Julia S. Wong
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Daphna Y. Spiegel
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA
| | - Alphonse Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Jennifer R. Bellon
- Department of Radiation Oncology, Brigham & Women's Hospital/Dana Farber Cancer Institute, Boston, MA
| | - Alice Y. Ho
- Department of Radiation Oncology, Duke University School of Medicine, Durham, NC
| |
Collapse
|
5
|
Gil GOB, de Andrade WP, Diniz PHC, Cantidio FS, Queiroz IN, Gil MLBV, Almeida CAM, Caldeira PPR, Regalin M, Silva-Filho AL. A phase II randomized clinical trial to assess toxicity and quality of life of breast cancer patients with hypofractionated versus conventional fractionation radiotherapy with regional nodal irradiation in the context of COVID-19 crisis. Front Oncol 2023; 13:1202544. [PMID: 37388233 PMCID: PMC10301738 DOI: 10.3389/fonc.2023.1202544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose This study, conducted during the COVID-19 crisis, primarily aimed to compare the acute toxicity between conventional fractionated radiation therapy (CF-RT) with hypofractionated radiation therapy (HF-RT) among patients who underwent breast-conserving surgery or mastectomy in whom breast or chest wall and regional nodal irradiation (RNI) were indicated. The secondary endpoints were both acute and subacute toxicity, cosmesis, quality of life, and lymphedema features. Methods In this open and non-inferiority randomized trial, patients (n = 86) were randomly allocated 2:1 in the CF-RT arm (n = 33; 50 Gy/25 fractions ± sequential boost [10 Gy/5 fractions]) versus the HF-RT arm (n = 53; 40 Gy/15 fractions ± concomitant boost [8 Gy/15 fractions]). Toxic effects and cosmesis evaluation used the Common Terminology Criteria for Adverse Events, version 4.03 (CTCAE) and the Harvard/National Surgical Adjuvant Breast and Bowel Project (NSABP)/Radiation Therapy Oncology Group (RTOG) scale. For the patient-reported quality of life (QoL), the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the breast cancer-specific supplementary questionnaire (QLQ-BR23) were used. Lymphedema was assessed by comparing volume differences between the affected and contralateral arms using the Casley-Smith formula. Results Grade 2 and grade 3 dermatitis were lower with HF-RT than with CF-RT (28% vs. 52%, and 0% vs. 6%, respectively; p = 0.022). HF-RT had a lower rate of grade 2 hyperpigmentation (23% vs. 55%; p = 0.005), compared to CF-RT. No other differences in overall rates of physician-assessed grade 2 or higher and grade 3 or higher acute toxicity between HF-RT and CF-RT were registered. There was no statistical difference between groups regarding cosmesis, lymphedema rate (13% vs. 12% HF-RT vs. CF-RT; p = 1.000), and functional and symptom scales, during both the irradiation period and after 6 months of the end of treatment. The results revealed that the subset of patients up to 65 years or older did not show a statistical difference between both arm fractionation schedules (p > 0.05) regarding skin rash, fibrosis, and lymphedema. Conclusion HF-RT was non-inferior to CF-RT, and moderate hypofractionation showed lower rates of acute toxicity, with no changes in quality-of-life outcomes. Clinical trial registration ClinicalTrials.gov, identifier NCT40155531.
Collapse
Affiliation(s)
- Gabriel Oliveira Bernardes Gil
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
| | - Warne Pedro de Andrade
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
- ONCOBIO, Grupo Oncoclinicas, Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Henrique Costa Diniz
- Department of Oncology, Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Farley Soares Cantidio
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | - Izabella Nobre Queiroz
- Department of Radiation Oncology, Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcos Regalin
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | - Agnaldo Lopes Silva-Filho
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
- Department of Radiation Oncology, Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
6
|
Mushonga M, Weiss J, Liu ZA, Nyakabau AM, Mohamad O, Tawk B, Moraes FY, Grover S, Yap ML, Zubizarreta E, Lievens Y, Rodin D. Hypofractionation in Breast Cancer Radiotherapy Across World Bank Income Groups: Results of an International Survey. JCO Glob Oncol 2023; 9:e2200127. [PMID: 36706350 PMCID: PMC10166450 DOI: 10.1200/go.22.00127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Hypofractionated breast radiotherapy has been found to be equivalent to conventional fractionation in many clinical trials. Using data from the European Society for Radiotherapy and Oncology Global Impact of Radiotherapy in Oncology survey, we identified preferences for hypofractionation in breast cancer across World Bank income groups and the perceived facilitators and barriers to its use. MATERIALS AND METHODS An international, electronic survey was administered to radiation oncologists from 2018 to 2019. Demographics, practice characteristics, preferred hypofractionation regimen for specific breast cancer scenarios, and facilitators and barriers to hypofractionation were reported and stratified by World Bank income groups. Variables associated with hypofractionation were assessed using multivariate logistic regression models. RESULTS One thousand four hundred thirty-four physicians responded: 890 (62%) from high-income countries (HICs), 361 (25%) from upper-middle-income countries (UMICs), 183 (13%) from low- and lower-middle-income countries (LLMICs). Hypofractionation was preferred most frequently in node-negative disease after breast-conserving surgery, with the strongest preference reported in HICs (78% from HICs, 54% from UMICs, and 51% from LLMICs, P < .001). Hypofractionation for node-positive disease postmastectomy was more frequently preferred in LLMICs (28% from HICs, 15% from UMICs, and 35% from LLMICs, P < .001). Curative doses of 2.1 to < 2.5 Gy in 15-16 fractions were most frequently reported, with limited preference for ultra-hypofractionation, but significant variability in palliative dosing. In adjusted analyses, UMICs were significantly less likely than LLMICs to prefer hypofractionation across all curative clinical scenarios, whereas respondents with > 1 million population catchments and with intensity-modulated radiotherapy were more likely to prefer hypofractionation. The most frequently cited facilitators and barriers were published evidence and fear of late toxicity, respectively. CONCLUSION Preference for hypofractionation varied for curative indications, with greater acceptance in earlier-stage disease in HICs and in later-stage disease in LLMICs. Targeted educational interventions and greater inclusivity in radiation oncology clinical trials may support greater uptake.
Collapse
Affiliation(s)
- Melinda Mushonga
- Sally Mugabe Central Hospital, Harare, Zimbabwe.,Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Weiss
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna-Mary Nyakabau
- Department of Oncology, Faculty of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Bouchra Tawk
- German Cancer Research Consortium, Core Site Heidelberg, German Cancer Research Center, Heidelberg, Germany.,Division of Molecular and Translational Radiation Oncology, Department of Radiation Oncology, Heidelberg Faculty of Medicine and Heidelberg University Hospital, Heidelberg, Germany
| | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mei Ling Yap
- Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, Australia.,School of Public Health, Faculty of Medicine and Health, University of Sydney, Campbelltown, Australia
| | | | - Yolande Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Heritage S, Sundaram S, Kirkby NF, Kirkby KJ, Mee T, Jena R. An Update to the Malthus Model for Radiotherapy Utilisation in England. Clin Oncol (R Coll Radiol) 2023; 35:e1-e9. [PMID: 35835634 DOI: 10.1016/j.clon.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/17/2022] [Accepted: 06/16/2022] [Indexed: 01/05/2023]
Abstract
AIMS The Malthus Programme predicts national and local radiotherapy demand by combining cancer incidence data with decision trees detailing the indications, and appropriate dose fractionation, for radiotherapy. Since the last model update in 2017, technological advancements and the COVID-19 pandemic have led to increasing hypofractionation of radiotherapy schedules. Indications for radiotherapy have also evolved, particularly in the context of oligometastatic disease. Here we present a brief update on the model for 2021. We have updated the decision trees for breast, prostate, lung and head and neck cancers, and incorporated recent cancer incidence data into our model, generating a current estimate of fraction demand for these four cancer sites across England. MATERIALS AND METHODS The decision tree update was based on evidence from practice-changing randomised controlled trials, published guidelines, audit data and expert opinion. Site- and stage-specific incidence data were taken from the National Disease Registration Service. We used the updated model to estimate the proportion of patients who would receive radiotherapy (appropriate rate of radiotherapy) and the fraction demand per million population at a national and Clinical Commissioning Group level in 2021. RESULTS The total predicted fraction demand has decreased by 11.4% across all four cancer sites in our new model, compared with the 2017 version. This reduction can be explained primarily by greater use of hypofractionated treatments (including stereotactic ablative radiotherapy) and a shift towards earlier stage presentation. The only large change in appropriate rate of radiotherapy was an absolute decrease of 3% for lung cancer. CONCLUSIONS Compared with our previous model, the current version predicts a reduction in fraction demand across England. This is driven principally by hypofractionation of radiotherapy regimens, using technology that requires increasingly complex planning. Treatment complexity and local service factors need to be taken into account when translating fraction burden into linear accelerator demand or throughput.
Collapse
Affiliation(s)
- S Heritage
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - S Sundaram
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - N F Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - K J Kirkby
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - T Mee
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R Jena
- Department of Oncology, University of Cambridge, Cambridge, UK.
| |
Collapse
|
8
|
Al-Rashdan A, Deban M, Quan ML, Cao JQ. Locoregional Management of Breast Cancer: A Chronological Review. Curr Oncol 2022; 29:4647-4664. [PMID: 35877229 PMCID: PMC9321012 DOI: 10.3390/curroncol29070369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Locoregional management of breast cancer is founded on evidence generated over a vast time period, much longer than the career span of many practicing physicians. Oncologists rely on specific patient and tumour characteristics to recommend modern-day treatments. However, some of this information may not have been available during prior periods in which the evidence was generated. For example, the comprehensive Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) meta-analyses published in the 2000s typically included older trials accruing patients between the 1960s and 1980s. This raises some uncertainty about whether conclusions from studies conducted in prior eras are as relevant or applicable to modern-day patients and treatments. Reviewing the chronological order and details of the evidence can be beneficial to understanding these nuances. This review discusses the evolution of locoregional management through some key clinical trials. We aim to highlight the time period in which the evidence was generated and emphasize the 10-year outcomes for the comparability of results. Evidence supporting surgical management of the breast and axilla, as well as details of radiotherapy are discussed briefly for all stages of breast cancer.
Collapse
Affiliation(s)
- Abdulla Al-Rashdan
- Dalhousie University School of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada;
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
| | - Melina Deban
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
| | - May Lynn Quan
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
| | - Jeffrey Q. Cao
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.D.); (M.L.Q.)
- Division of Radiation Oncology, Tom Baker Cancer Centre, 1331 29 St. NW, Calgary, AB T2N 4N2, Canada
- Correspondence: or ; Tel.: +1-403-521-3196; Fax: +1-403-283-1651
| |
Collapse
|
9
|
Jacqmin DJ, Crosby JSM. The impact of COVID-19 on a high-volume incident learning system: A retrospective analysis. J Appl Clin Med Phys 2022; 23:e13653. [PMID: 35616007 PMCID: PMC9278685 DOI: 10.1002/acm2.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of this work was to assess how the coronavirus disease 2019 (COVID-19) pandemic impacted our incident learning system data and communicate the impact of a major exogenous event on radiation oncology clinical practice. METHODS Trends in our electronic incident reporting system were analyzed to ascertain the impact of the COVID-19 pandemic, including any direct clinical changes. Incident reports submitted in the 18 months prior to the pandemic (September 14, 2018 to March 13, 2020) and reports submitted during the first 18 months of the pandemic (March 14, 2020 to September 13, 2021) were compared. The incident reports include several data elements that were evaluated for trends between the two time periods, and statistical analysis was performed to compare the proportions of reports. RESULTS In the 18 months prior to COVID-19, 192 reports were submitted per 1000 planning tasks (n = 832 total). In the first 18 months of the pandemic, 147 reports per 1000 planning tasks were submitted (n = 601 total), a decrease of 23.4%. Statistical analysis revealed that there were no significant changes among the data elements between the pre- and during COVID-19 time periods. An analysis of the free-text narratives in the reports found that phrases related to pretreatment imaging were common before COVID-19 but not during. Conversely, phrases related to intravenous contrast, consent for computed tomography, and adaptive radiotherapy became common during COVID-19. CONCLUSIONS The data elements captured by our incident learning system were stable after the onset of the COVID-19 pandemic, with no statistically significant findings after correction for multiple comparisons. A trend toward fewer reports submitted for low-risk issues was observed. The methods used in the work can be generalized to events with a large-scale impact on the clinic or to monitor an incident learning system to drive future improvement activities.
Collapse
Affiliation(s)
- Dustin J. Jacqmin
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Jennie S. M. Crosby
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| |
Collapse
|
10
|
Healthcare Disparities and Outcomes of Cancer Patients in a Community Setting from a COVID-19 Epicenter. Curr Oncol 2022; 29:1150-1162. [PMID: 35200597 PMCID: PMC8870882 DOI: 10.3390/curroncol29020098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/08/2023] Open
Abstract
There have been numerous studies demonstrating how cancer patients are at an increased risk of mortality. Within New York City, our community hospital emerged as an epicenter of the first wave of the pandemic in the spring of 2020 and serves a unique population that is predominately uninsured, of a lower income, and racially/ethnically diverse. In this single institution retrospective study, the authors seek to investigate COVID-19 diagnosis, severity and mortality in patients with an active cancer diagnosis. Demographic, clinical characteristics, treatment, SARS-CoV-2 laboratory results, and outcomes were evaluated. In our community hospital during the first wave of the COVID-19 pandemic in the United States, patients with active cancer diagnosis appear to be at increased risk for mortality (30%) and severe events (50%) due to the SARS-CoV-2 infection compared to the general population. A higher proportion of active cancer patients with Medicaid insurance, Hispanic ethnicity, other race, and male sex had complications and death from COVID-19 infection. The pandemic has highlighted the health inequities that exist in vulnerable patient populations and underserved communities such as ours.
Collapse
|
11
|
Ivanov O, Licina J, Petrovic B, Trivkovic J, Marjanovic M. Implementation of accelerated partial breast irradiation at the Oncology Institute of Vojvodina. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh200422010i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Early breast cancer is usually treated with breast conserving
surgery followed by radiation treatment. Whole breast irradiation is
standard of care so far, but currently there is an increasement in
accelerated partial breast irradiation for selected patients which showed
many advantages. The aim of this paper is to present the implementation of
the accelerated partial breast irradiation in Oncology Institute of
Vojvodina. Case outline. A 54-year-old woman was referred to radiotherapy
after breast conserving surgery. After she met all of the inclusion
criteria, she underwent accelerated partial breast irradiation with 38.5 Gy
in 10 fractions. Active breathing control device was used during the
treatment and cone beam computed tomography was performed before each
fraction for purpose of target position control. She terminated therapy in
good health condition with only adverse effect of mild radiation dermatitis
of irradiated area. On the first follow up, she was without any symptom or
sign of disease or complication. Conclusion. Accelerated partial breast
irradiation is safe and effective. Radiation oncologist should be encouraged
to implement this technique.
Collapse
Affiliation(s)
- Olivera Ivanov
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Jelena Licina
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Borislava Petrovic
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Sciences, Department of Physics, Novi Sad, Serbia
| | | | - Milana Marjanovic
- Oncology Institute of Vojvodina, Sremska Kamenica, Serbia + University of Novi Sad, Faculty of Sciences, Department of Physics, Novi Sad, Serbia
| |
Collapse
|
12
|
Frederick A, Roumeliotis M, Grendarova P, Quirk S. Performance of a knowledge-based planning model for optimizing intensity-modulated radiotherapy plans for partial breast irradiation. J Appl Clin Med Phys 2021; 23:e13506. [PMID: 34936195 PMCID: PMC8906226 DOI: 10.1002/acm2.13506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate a knowledge‐based (KB) planning model for RapidPlan, generated using a five‐field intensity‐modulated radiotherapy (IMRT) class solution beam strategy and rigorous dosimetric constraints for accelerated partial breast irradiation (APBI). Materials and methods The RapidPlan model was configured using 64 APBI treatment plans and validated for 120 APBI patients who were not included in the training dataset. KB plan dosimetry was compared to clinical plan dosimetry, the clinical planning constraints, and the constraints used in phase III APBI trials. Dosimetric differences between clinical and KB plans were evaluated using paired two‐tailed Wilcoxon signed‐rank tests. Results KB planning was able to produce IMRT‐based APBI plans in a single optimization without manual intervention that are comparable or better than the conventionally optimized, clinical plans. Comparing KB plans to clinical plans, differences in PTV, heart, contralateral breast, and ipsilateral lung dose–volume metrics were not clinically significant. The ipsilateral breast volume receiving at least 50% of the prescription dose was statistically and clinically significantly lower in the KB plans. Conclusion KB planning for IMRT‐based APBI provides equivalent or better dosimetry compared to conventional inverse planning. This model may be reliably applied in clinical practice and could be used to transfer planning expertise to ensure consistency in APBI plan quality.
Collapse
Affiliation(s)
- Amy Frederick
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
| | - Michael Roumeliotis
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Petra Grendarova
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Radiation OncologyGrande Prairie Cancer CentreGrande PrairieAlbertaCanada
| | - Sarah Quirk
- Department of Physics and AstronomyUniversity of CalgaryCalgaryAlbertaCanada
- Division of Medical PhysicsTom Baker Cancer CentreCalgaryAlbertaCanada
- Department of OncologyUniversity of CalgaryCalgaryAlbertaCanada
| |
Collapse
|
13
|
Milch V, Wang R, Der Vartanian C, Austen M, Hector D, Anderiesz C, Keefe D. Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice. Med J Aust 2021; 215:479-484. [PMID: 34689343 PMCID: PMC8662192 DOI: 10.5694/mja2.51304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Introduction Driven by the need to reduce risk of SARS‐CoV‐2 infection and optimise use of health system resources, while maximising patient outcomes, the COVID‐19 pandemic has prompted unprecedented changes in cancer care. Some new or modified health care practices adopted during the pandemic will be of long term value in improving the quality and resilience of cancer care in Australia and internationally. The Cancer Australia consensus statement is intended to guide and enhance the delivery of cancer care during the pandemic and in a post‐pandemic environment. This article summarises the full statement, which is available at https://www.canceraustralia.gov.au/covid‐19/covid‐19‐recovery‐implications‐cancer‐care. Main recommendations The statement is informed by a desktop literature review and input from cancer experts and consumers at a virtual roundtable, held in July 2020, on key elements of cancer care that changed during the pandemic. It describes targeted strategies (at system, service, practitioner and patient levels) to retain, enhance and embed high value changes in practice. Principal strategies include:
implementing innovative models of care that are digitally enabled and underpinned by clear governance, policies and procedures to guide best practice cancer care; enabling health professionals to deliver evidence‐based best practice and coordinated, person‐centred cancer care; and empowering patients to improve health literacy and enhancing their ability to engage in informed, shared decision making.
Changes in management as a result of this statement Widespread adoption of high value health care practices across all levels of the cancer control sector will be of considerable benefit to the delivery of optimal cancer care into the future.
Collapse
Affiliation(s)
| | | | | | | | | | - Cleola Anderiesz
- Cancer Australia, Sydney, NSW.,Centre for Health Policy, University of Melbourne, Melbourne, VIC
| | | |
Collapse
|
14
|
Yang J, Qi SN, Fang H, Song YW, Jin J, Liu YP, Wang WH, Yang Y, Tang Y, Ren H, Chen B, Lu NN, Tang Y, Li N, Jing H, Wang SL, Li YX. Cost-effectiveness of postmastectomy hypofractionated radiation therapy vs conventional fractionated radiation therapy for high-risk breast cancer. Breast 2021; 58:72-79. [PMID: 33933925 PMCID: PMC8105681 DOI: 10.1016/j.breast.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 01/01/2023] Open
Abstract
Background The phase 3 NCT00793962 trial demonstrated that postmastectomy hypofractionated radiation therapy (HFRT) was noninferior to conventional fractionated radiation therapy (CFRT) in patients with high-risk breast cancer. This study assessed the cost-effectiveness of postmastectomy HFRT vs CFRT based on the NCT00793962 trial. Methods A Markov model was adopted to synthesize the medical costs and health benefits of patients with high-risk breast cancer based on data from the NCT00793962 trial. Main outcomes were discounted lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). We employed a time-dependent horizon from Chinese, French and USA payer perspectives. Model robustness was evaluated with one-way and probabilistic sensitivity analyses. Results Patients receiving CFRT versus HFRT gained an incremental 0.0163 QALYs, 0.0118 QALYs and 0.0028 QALYs; meanwhile an incremental cost of $2351.92, $4978.34 and $8812.70 from Chinese, French and USA payer perspectives, respectively. Thus CFRT versus HFRT yielded an ICER of $144,281.47, $420,636.10 and $3,187,955.76 per QALY from Chinese, French and USA payer perspectives, respectively. HFRT could maintain a trend of >50% probabilities of cost-effectiveness below a willingness-to-pay (WTP) of $178,882.00 in China, while HFRT was dominant relative to CFRT, regardless of the WTP values in France and the USA. Sensitivity analyses indicated that the ICERs were most sensitive to the parameters of overall survival after radiotherapy. Conclusions Postmastectomy HFRT could be used as a cost-effective substitute for CFRT in patients with high-risk breast cancer and should be considered in appropriately selected patients. HFRT is a cost-effective substitute for CFRT for women with high-risk breast cancer. The incremental cost-effectiveness ratio varied in a time-dependent manner and increased with the time horizon. Overall survival were the most influential parameter on the incremental cost-effectiveness ratio.
Collapse
Affiliation(s)
- Jing Yang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hui Fang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yong-Wen Song
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jing Jin
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yue-Ping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wei-Hu Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yu Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hua Ren
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Bo Chen
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ning-Ning Lu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ning Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hao Jing
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Shu-Lian Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
| |
Collapse
|
15
|
Vaandering A, Ben Mustapha S, Lambrecht M, Van Gestel D, Veldmeman L. Impact of the COVID-19 Pandemic on Patients and Staff in Radiation Oncology Departments in Belgium: A National Survey. Front Oncol 2021; 11:654086. [PMID: 33816310 PMCID: PMC8017334 DOI: 10.3389/fonc.2021.654086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/23/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: COVID-19 reached Belgium in February and quickly became a major public health challenge. It is of importance to evaluate the actual impact of COVID-19 on patients and staff in Belgian radiotherapy departments (RTDs). This was evaluated through a weekly national survey sent to departments measuring key factors that were affected by the pandemic. Materials and Methods: The Belgian SocieTy for Radiation Oncology (BeSTRO) together with the Belgian College for physicians in Radiation Oncology invited all 26 RTD to participate in a survey that started on March 2nd and was re- submitted weekly for 4 months to assess variations in time. The survey focused on: (1) the COVID-19 status of patients and staff; (2) the management of clinically suspected COVID patients and COVID positive patients; (3) the impact of COVID-19 on RTD activities; (4) its impact in radiotherapy indications and fractionation schemes. Results: Seventy-three percent of 26 RTDs completed the first survey and 57% responded to all weekly surveys. In the RTD staff, 24 members were COVID-positive of whom 67% were RTTs. Over the study period, the number of patients treated dropped by a maximum of 18.8% when compared to March 2nd. In 32.3% of COVID-positive and 54% of COVID suspected patients, treatment was continued without any interruptions. Radiotherapy indications were adapted within the 1st weeks of the survey in 47.4% of RTD, especially for urological and breast tumors. Fractionation schemes were changed in 68.4% of RTD, mainly for urological, breast, gastro-intestinal, and lung tumors. Conclusions: Between March and June 2020, the COVID-19 pandemic resulted in an important decrease in treatment activity in RTD in Belgium (18.8%). The COVID-19 infection status of patients influenced the continuity of the radiotherapy schedule. Changes in indications and fractionation schedules of radiotherapy were rapidly incorporated in the different RTD.
Collapse
Affiliation(s)
- Aude Vaandering
- Radiation Oncology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.,Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Selma Ben Mustapha
- Department of Radiation Oncology, Centre Hospitalier Universitaire (CHU) de Liège, University of Liège, Liège, Belgium
| | - Maarten Lambrecht
- Department of Radiotherapy-Oncology, Leuven Kanker Instituut, Universitair Ziekenhuis (UZ) Gasthuisberg, Leuven, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Liv Veldmeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
16
|
Pacheco RL, Martimbianco ALC, Roitberg F, Ilbawi A, Riera R. Impact of Strategies for Mitigating Delays and Disruptions in Cancer Care Due to COVID-19: Systematic Review. JCO Glob Oncol 2021; 7:342-352. [PMID: 33656910 PMCID: PMC8081509 DOI: 10.1200/go.20.00632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.
Collapse
Affiliation(s)
- Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil
| | - Ana Luiza Cabrera Martimbianco
- Centro Universitário São Camilo (CUSC), São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Programa de Pós-graduação em Saúde e Meio Ambiente, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Felipe Roitberg
- Instituto do Câncer do Estado de São Paulo/HCFMUSP, World Health Organization (WHO), São Paulo, Brazil.,Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland.,European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil.,Oxford-Brazil EBM Alliance, Petropolis, Brazil.,Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| |
Collapse
|
17
|
Taylor JM, Song A, Nowak K, Dan T, Simone B, Harrison A, Doyle L, Lockamy V, Anne P, Simone N. Dosimetric Comparisons of Simulation Techniques for Left-Sided Breast Cancer in the COVID-19 Era: Techniques to Reduce Viral Transmission and Respect the Therapeutic Ratio. Cureus 2021; 13:e13354. [PMID: 33747655 PMCID: PMC7968704 DOI: 10.7759/cureus.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The COVID-19 pandemic challenges our ability to safely treat breast cancer patients and requires revisiting current techniques to evaluate optimal strategies. Potential long-term sequelae of breast radiation have been addressed by deep inspiration breath-hold (DIBH), prone positioning, and four-dimensional computed tomography (4DCT) average intensity projection (AveIP)-based planning techniques. Dosimetric comparisons to determine the optimal technique to minimize the normal tissue dose for left-sided breast cancers have not been performed. Methods Ten patients with left-sided, early-stage breast cancer undergoing whole breast radiation were simulated in the prone position, supine with DIBH, and with a free-breathing 4DCT scan. The target and organs at risk (OAR) contours were delineated in all scans. Target volume coverage and OAR doses were assessed. One-way analysis of variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to detect differences in dosimetric parameters among the different treatment plans. Significance was set as p < 0.05. Results We demonstrate differences in heart and lung dose by the simulation technique. The mean heart doses in the prone, DIBH, and AveIP plans were 129 cGy, 154 cGy, and 262 cGy, respectively (p=0.02). The lung V20 in the prone, DIBH, and AveIP groups was 0.5%, 10.3% and 9.5%, respectively (p <0.001). Regardless of technique, lumpectomy planning target volume (PTV) coverage did not differ between the three plans with 95% of the lumpectomy PTV volume covered by 100.4% in prone plans, 98.5% in AveIP plans, and 99.3% in DIBH plans (p=0.7). Conclusions Prone positioning provides dosimetric advantages as compared to DIBH. When infection risks are considered as in the current coronavirus disease 2019 (COVID-19) pandemic, prone plans have advantages in reducing the risk of disease transmission. In instances where prone positioning is not feasible, obtaining an AveIP simulation may be useful in more accurately assessing heart and lung toxicity and informing a risk/benefit discussion of DIBH vs free breath-hold techniques.
Collapse
Affiliation(s)
- James M Taylor
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Andrew Song
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Kamila Nowak
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Tu Dan
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Brittany Simone
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Amy Harrison
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Laura Doyle
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Virginia Lockamy
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Pramila Anne
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Nicole Simone
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| |
Collapse
|
18
|
Shinan-Altman S, Levkovich I. COVID-19 precautionary behavior among Israeli breast cancer patients. Support Care Cancer 2021; 29:4075-4080. [PMID: 33404805 PMCID: PMC7785909 DOI: 10.1007/s00520-020-05948-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/11/2020] [Indexed: 12/23/2022]
Abstract
Objective Cumulative knowledge indicates that cancer patients, among them breast cancer patients, are more susceptible to COVID-19 than individuals without cancer. Therefore, these patients need to take additional precautions against the COVID-19 outbreak. This study aimed to examine factors associated with precautionary behavior among Israeli breast cancer patients during the COVID-19 pandemic. Methods A cross-sectional study was conducted among 151 women with breast cancer. Participants completed measures of knowledge about COVID-19, perceived threat, sense of mastery, social support, precautionary behavior, and socio-demographic questionnaires. A multivariate regression model was calculated with precautionary behavior as the dependent variable. Results The mean of precautionary behavior score was relatively high. Participants perceived their health as relatively good, had relatively high knowledge about COVID-19, and moderate perceived threat. Sense of mastery was relatively moderate and perceived social support was relatively high. In the multivariate regression analysis, after controlling for the background variables, knowledge about COVID-19 (F(2,149) = 8.68, p < 0.001; beta = 0.36) was significantly associated with precautionary behavior. This variable explained 15.4% of the precautionary behavior variance. Conclusion Findings suggest that in order to enhance precautionary behavior among women with breast cancer during a pandemic outbreak, it is recommended to pay attention their knowledge about the virus.
Collapse
Affiliation(s)
- Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 52900, Ramat-Gan, Israel.
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College of Education, Kiryat Tiv'on, Israel
| |
Collapse
|
19
|
Murakami N, Mori T, Machida R, Kodaira T, Ito Y, Shikama N, Konishi K, Matsumoto Y, Murakami Y, Nakamura N, Yamashita H, Yorozu A, Yoshimura M, Inoue K, Nozaki M, Ishikura S, Itami J, Nishimura Y, Kagami Y. Prognostic Value of Epithelial Cell Adhesion Molecules in T1-2N0M0 Glottic Cancer. Laryngoscope 2020; 131:1522-1527. [PMID: 33369763 DOI: 10.1002/lary.29348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/03/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This is an ancillary study of a multi-institutional randomized non-inferiority phase III trial of accelerated fractionation (AF) versus standard fractionation (SF) radiation therapy for T1-2N0M0 glottic cancer (JCOG0701). Biopsy specimens of tumors from the patients enrolled in the JCOG0701 are collected and the association between clinical outcomes and histopathologic features such as expression of epithelial cell adhesion molecule (EpCAM), p53, and p16 were investigated. METHODS Five slices of undyed slides from biopsy specimens were sent to the National Cancer Center Hospital and all the specimens were assessed for the expression of EpCAM, p53, and p16. The primary objective was to investigate the association between 3-year progression-free survival (PFS) and expression of EpCAM, p53, and p16. RESULTS A total of 88 out of 370 patients were enrolled in this ancillary study. The 3-year PFS for tumors with strong expression of EpCAM was 70.6% (95% CI 43.1%-86.6%), while that of tumors without strong expression of EpCAM was 77.5% (95% CI 65.9%-85.5%) with no remarkable difference between groups (P = .67). Likewise, there was no significant difference in 3-year PFS between tumors regardless of p53 or p16 status. However, in a subgroup analysis for 17 patients with a strong expression of EpCAM, AF showed better 3-year PFS than SF (100% vs 54.5%, P = .07). CONCLUSIONS From the current study, it could not be concluded that EpCAM, p16, and p53 were prognostic factors for early-stage glottic cancer after primary radiation therapy. AF might be an appropriate fractionation for tumors with a strong expression of EpCAM. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1522-1527, 2021.
Collapse
Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yoshinori Ito
- Division of Radiation Oncology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuo Matsumoto
- Department of Radiation Oncology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Inoue
- Division of Radiation Therapy, Tochigi Cancer Center, Utsunomiya, Japan
| | - Miwako Nozaki
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Satoshi Ishikura
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoshikazu Kagami
- Division of Radiation Oncology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Leonardi MC, Montagna E, Galimberti VE, Zaffaroni M, Rojas DP, Dicuonzo S, Zerella MA, Morra A, Sangalli C, Gandini S, Colleoni M, Veronesi P, Gerardi MA, Alterio D, Lazzari R, Sarra Fiore M, Bufi G, Cattani F, Mastrilli F, Orecchia R, Jereczek-Fossa BA. Breast Adjuvant Radiotherapy Amid the COVID-19 Crisis in a Hub Cancer Center, Lombardy, Italy. BREAST CARE (BASEL, SWITZERLAND) 2020; 5:1-7. [PMID: 34191930 PMCID: PMC7801963 DOI: 10.1159/000513227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
Introduction During the COVID-19 pandemic, Lombardy (Northern Italy) Regional Health Council created hubs for cancer care, meant to be SARS-CoV-2-free pathways for cancer patients. The workflow of breast cancer (BC) radiotherapy (RT) in one of the hubs is presented here. Methods Candidates to adjuvant RT during the pandemic peak of March-April 2020 were compared to those treated in the same period of 2019, and patient volume, deferral rate, and type of RT were analyzed. Statistics were calculated with χ<sup>2</sup> or Fisher exact tests for categorical variables, and the Wilcoxon rank test for continuous variables. Results In March-April 2020 the BC patient volume increased by 28% compared to the same period in 2019 (scheduled patients: 175 vs. 137) and amid travel restrictions it was kept high (treated patients: 136 vs. 133), mainly due to an influx from across Lombardy. RT schemes basically did not change, being already centered on hypofractionation. The increase of median time (67 vs. 74.5 days in 2019 and 2020, respectively) to the commencement of RT for low-risk patients was clinically negligible yet statistically significant (p = 0.03), and in line with the pertinent recommendations. No significant difference was found in the time interval between treatments and RT for high-risk patients. Concomitant chemoradiotherapy was avoided throughout the pandemic peak. Twenty-one women (13.6%) delayed either computed tomography simulation or RT commencement mainly because of COVID-19-related concerns and mobility restrictions. Conclusion The workload for BC was high during the pandemic peak. Hubs allowed the continuation of oncologic treatments, while mitigating the strain on frontline COVID-19 hospitals.
Collapse
Affiliation(s)
| | - Emilia Montagna
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Damaris Patricia Rojas
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Anna Morra
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Claudia Sangalli
- Division of Data Management, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Veronesi
- Division of Breast Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberta Lazzari
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Massimo Sarra Fiore
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Giammaria Bufi
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fabrizio Mastrilli
- Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
21
|
Cavalcante FP, Novita GG, Millen EC, Zerwes FP, de Oliveira VM, Sousa ALL, Freitas Junior R. Management of early breast cancer during the COVID-19 pandemic in Brazil. Breast Cancer Res Treat 2020; 184:637-647. [PMID: 32803637 PMCID: PMC7429139 DOI: 10.1007/s10549-020-05877-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/10/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. METHODS An electronic survey was conducted with members of the Brazilian Society of Breast Cancer Specialists (SBM) between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to breast cancer subtype and oncoplastic surgery. RESULTS The response rate was 34.4% (503/1462 specialists). Most of the respondents (324; 64.4%) lived in a state capital city, were board-certified as breast specialists (395; 78.5%) and either worked in an academic institute or one associated with breast cancer treatment (390; 77.5%). The best response rate was from the southeast of the country (240; 47.7%) followed by the northeast (128; 25.4%). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p < 0.001). The southeast of the country (p = 0.005) and the state capital cities (p < 0.001) were associated with changes at the beginning of the pandemic, while being female (p = 0.001) was associated with changes during the pandemic. For hormone receptor-positive tumors with the best prognosis (Ki-67 < 20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki-67 > 30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p < 0.00001). For tumors ≥ 1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2 + tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation. CONCLUSIONS Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.
Collapse
Affiliation(s)
| | | | | | - Felipe Pereira Zerwes
- Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Ruffo Freitas Junior
- Advanced Center for Diagnosis and Treatment for Breast Cancer (CORA), Federal University of Goiás, Goiânia, Goiás Brazil
| |
Collapse
|
22
|
Elghazawy H, Bakkach J, Zaghloul MS, Abusanad A, Hussein MM, Alorabi M, eldin NB, Helal T, Zaghloul TM, Venkatesulu BP, Elghazaly H, Al-Sukhun S. Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic. Future Oncol 2020; 16:2551-2567. [PMID: 32715776 PMCID: PMC7386379 DOI: 10.2217/fon-2020-0574] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Hagar Elghazawy
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Joaira Bakkach
- Biomedical Genomics & Oncogenetics Research Laboratory. Faculty of Sciences and Techniques of Tangier. Abdel Malek Essaadi University, Tangier 90000, Morocco
| | - Mohamed S Zaghloul
- Department of Radiotherapy, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | - Atlal Abusanad
- Department of Medicine, Oncology Division, King Abdulaziz University, Jeddah 23221, Saudi Arabia
| | - Mariam Mohamed Hussein
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Mohamed Alorabi
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Nermean Bahie eldin
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Thanaa Helal
- Department of Pathology, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Tarek M Zaghloul
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo 12622, Egypt
| | | | - Hesham Elghazaly
- Department of Clinical Oncology, Faculty of medicine, Ain Shams University Hospitals, Cairo 11566, Egypt
| | - Sana Al-Sukhun
- Al-Hyatt Oncology Center, Faculty of medicine, Jordan University, Amman 11183, Jordan
| |
Collapse
|
23
|
Hinduja RH, George K, Barthwal M, Pareek V. Radiation oncology in times of COVID-2019: A review article for those in the eye of the storm - An Indian perspective. Semin Oncol 2020; 47:315-327. [PMID: 32819712 PMCID: PMC7357513 DOI: 10.1053/j.seminoncol.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023]
Abstract
The global COVID-2019 pandemic has presented to the field of radiation oncology a management dilemma in providing evidence-based treatments to all cancer patients. There is a need for appropriate measures to be taken to reduce infectious spread between the medical healthcare providers and the patient population. Such times warrant resource prioritization and to continue treatment with best available evidence, thereby reducing the risk of COVID-2019 transmission in times where the workforce is reduced. There has been literature presented in different aspects related to providing safety measures, running of a radiation department and for the management of various cancer subsites. In this article, we present a comprehensive review for sustaining a radiation oncology department in times of the COVID-2019 pandemic.
Collapse
Affiliation(s)
- Ritika Harjani Hinduja
- Associate Consultant, Department of Radiation Oncology, P.D Hinduja Hospital, Mumbai, India.
| | - Karishma George
- Junior Consultant, Department of Radiation Oncology, Vivekanand Cancer Hospital and Optimus Oncology Centre, Latur, India.
| | - Mansi Barthwal
- Senior Resident, Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India.
| | - Vibhay Pareek
- Senior Resident, Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India.
| |
Collapse
|
24
|
Thomson DJ, Yom SS, Saeed H, El Naqa I, Ballas L, Bentzen SM, Chao ST, Choudhury A, Coles CE, Dover L, Guadagnolo BA, Guckenberger M, Hoskin P, Jabbour SK, Katz MS, Mukherjee S, Rembielak A, Sebag-Montefiore D, Sher DJ, Terezakis SA, Thomas TV, Vogel J, Estes C. Radiation Fractionation Schedules Published During the COVID-19 Pandemic: A Systematic Review of the Quality of Evidence and Recommendations for Future Development. Int J Radiat Oncol Biol Phys 2020; 108:379-389. [PMID: 32798063 PMCID: PMC7834196 DOI: 10.1016/j.ijrobp.2020.06.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. METHODS AND MATERIALS Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. RESULTS From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. CONCLUSIONS A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
Collapse
Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Hina Saeed
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Leslie Ballas
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Soren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Laura Dover
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Mount Vernon Cancer Centre, Northwood, and University of Manchester, Manchester, United Kingdom
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, Massachusetts
| | | | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | - David J Sher
- Department of Radiation Oncology, University of Texas - Southwestern, Dallas, Texas
| | | | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | | |
Collapse
|
25
|
Zaniboni A, Ghidini M, Grossi F, Indini A, Trevisan F, Iaculli A, Dottorini L, Moleri G, Russo A, Vavassori I, Brevi A, Rausa E, Boni L, Dondossola D, Valeri N, Ghidini A, Tomasello G, Petrelli F. A Review of Clinical Practice Guidelines and Treatment Recommendations for Cancer Care in the COVID-19 Pandemic. Cancers (Basel) 2020; 12:E2452. [PMID: 32872421 PMCID: PMC7565383 DOI: 10.3390/cancers12092452] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023] Open
Abstract
The COVID-19 pandemic has inevitably caused those involved in cancer care to change clinical practice in order to minimize the risk of infection while maintaining cancer treatment as a priority. General advice during the pandemic suggests that most patients continue with ongoing therapies or planned surgeries, while follow-up visits may instead be delayed until the resolution of the outbreak. We conducted a literature search using PubMed to identify articles published in English language that reported on care recommendations for cancer patients during the COVID-19 pandemic from its inception up to 1st June 2020, using the terms "(cancer or tumor) AND (COVID 19)". Articles were selected for relevance and split into five categories: (1) personal recommendations of single or multiple authors, (2) recommendations of single authoritative centers, (3) recommendations of panels of experts or of multiple regional comprehensive centers, (4) recommendations of multicenter cooperative groups, (5) official guidelines or recommendations of health authorities. Of the 97 included studies, 10 were personal recommendations of single or multiple independent authors, 16 were practice recommendations of single authoritative cancer centers, 35 were recommendations provided by panel of experts or of multiple regional comprehensive centers, 19 were cooperative group position papers, and finally, 17 were official guidelines statements. The COVID-19 pandemic is a global emergency, and has rapidly modified our clinical practice. Delaying unnecessary treatment, minimizing toxicity, and identifying care priorities for surgery, radiotherapy, and systemic therapies must be viewed as basic priorities in the COVID-19 era.
Collapse
Affiliation(s)
| | - Michele Ghidini
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Francesco Grossi
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Alice Indini
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | | | - Alessandro Iaculli
- Oncology Unit, ASST Bergamo Est, 24068 Seriate (BG), Italy; (A.I.); (L.D.)
| | - Lorenzo Dottorini
- Oncology Unit, ASST Bergamo Est, 24068 Seriate (BG), Italy; (A.I.); (L.D.)
| | - Giovanna Moleri
- Centro Servizi, Direzione Socio-Sanitaria, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Alessandro Russo
- Surgical Oncology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Ivano Vavassori
- Urology Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Alessandra Brevi
- Otorhinolaryngology-Head and Neck Surgery Unit, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy;
| | - Emanuele Rausa
- General Surgery 1 Unit, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, 20122 Milan, Italy
| | - Nicola Valeri
- Division of Molecular Pathology and Centre for Evolution and Cancer, The Institute of Cancer Research, London SW7 3RP, UK;
- Department of Medicine, The Royal Marsden Hospital, London SW3 6JJ, UK
| | | | - Gianluca Tomasello
- Oncology Unit, Fondazione IRCCS–Ca’ Granda, Ospedale Maggiore Policlinico Milan, 20122 Milan, Italy; (M.G.); (F.G.); (A.I.); (G.T.)
| | - Fausto Petrelli
- Oncology Unit, Medical Sciences Department, ASST Bergamo Ovest, 24047 Treviglio (BG), Italy
| |
Collapse
|
26
|
Brachytherapy practice during the COVID-19 pandemic: a review on the practice changes. J Contemp Brachytherapy 2020; 12:393-396. [PMID: 33293979 PMCID: PMC7690221 DOI: 10.5114/jcb.2020.97643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 01/23/2023] Open
Abstract
The COVID-19 pandemic has caused a havoc across the globe, and has significantly affected oncology services, especially radiation therapy due to the need of social distancing as a measure for the pandemic mitigation. Brachytherapy, being an integral part of radiation therapy, posts a dilemma related to the practice of evidence-based oncology. It requires a significant amount of resources and personnel, thereby increasing the risk of exposure to the virus. There has been a significant amount of papers published providing the best available alternatives to external radiation; however, there is a lack of literature on the practice of brachytherapy. In times of the pandemic, deploying brachytherapy as a treatment modality can act as a double-edged sword and therefore, judicious use is warranted in such times of crisis. In this article, we provide a comprehensive review of the role of brachytherapy in various forms and different malignancy sites.
Collapse
|
27
|
Elledge CR, Beriwal S, Chargari C, Chopra S, Erickson BA, Gaffney DK, Jhingran A, Klopp AH, Small W, Yashar CM, Viswanathan AN. Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations. Gynecol Oncol 2020; 158:244-253. [PMID: 32563593 PMCID: PMC7294297 DOI: 10.1016/j.ygyno.2020.06.486] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. METHODS An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. RESULTS Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. CONCLUSIONS The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.
Collapse
Affiliation(s)
- Christen R Elledge
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Catheryn M Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, CA, USA
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
28
|
Wang W, Hu K, Qiu J, Zhang F. Radiotherapy after the easing of public restrictions during COVID-19 epidemic. Radiat Oncol 2020; 15:166. [PMID: 32646454 PMCID: PMC7344027 DOI: 10.1186/s13014-020-01612-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
The daily new confirmed Coronavirus disease 2019 (COVID-19) cases have decreased in some European and Asian countries. Many countries and areas have started to ease public restrictions. Here, we share our experiences and recommendations on how to conduct radiotherapy after public restrictions have eased or upon reopening. Firstly, COVID-19 nucleic acid test screening should be performed for all new admitted patients in areas with enough test capability. Secondly, radiotherapy can be conducted reference to consensus or recommendations on radiotherapy during COVID-19. Thirdly, it is not the time to consider compromising the guidance and the guidance on radiotherapy workflow and protection procedures still should be strictly followed.
Collapse
Affiliation(s)
- Weiping Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
29
|
Koch CA, Lee G, Liu ZA, Liu FF, Fyles A, Han K, Barry A, Croke J, Rodin D, Helou J, Hahn E, Isfahanian N, DeRocchis J, Lofgren S, Purdie TG. Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada. Adv Radiat Oncol 2020; 5:749-756. [PMID: 32775788 PMCID: PMC7303606 DOI: 10.1016/j.adro.2020.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Mitigation strategies to balance the risk of coronavirus disease 2019 (COVID-19) infection against oncologic risk in patients with breast cancer undergoing radiation therapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiation therapy by oncologic risk and omission or deferral of radiation therapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers and preserves resources. Herein, we present our early response and adaptation of breast radiation therapy utilization during the COVID-19 pandemic at a large academic cancer center in Canada. Methods and Materials A state of emergency was announced in Ontario on March 17, 2020, owing to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast radiation therapy starts, type of breast radiation therapy, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019. Results After the declaration of emergency in Ontario, there was a decrease of 39% in radiation therapy starts in 2020 compared with 2019 (79 vs 129, P < .001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared with 2019 (46% vs 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiation therapy were aged >50 years in 2020, 66% (78 of 118) versus 83% (132 of 160) in 2019, P = .0027. Conclusions A significant reduction in breast radiation therapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiation therapy to patients associated with higher oncologic risk requiring RNI. A quick response to a health care crisis is critical and is of particular importance for higher volume cancer sites where the potential effect on resources is greater.
Collapse
Affiliation(s)
- Christine A Koch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Grace Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Zhihui A Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Anthony Fyles
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Jennifer Croke
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Joelle Helou
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Ezra Hahn
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Naghmeh Isfahanian
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| | - Jane DeRocchis
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanne Lofgren
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Thomas G Purdie
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department Radiation Oncology, University of Toronto, Ontario, Canada
| |
Collapse
|
30
|
Achard V, Aebersold DM, Allal AS, Andratschke N, Baumert BG, Beer KT, Betz M, Breuneval T, Bodis S, de Bari B, Förster R, Franzetti-Pellanda A, Guckenberger M, Herrmann E, Huck C, Khanfir K, Matzinger O, Peguret N, Pesce G, Putora PM, Reuter C, Richetti A, Vees H, Vrieling C, Zaugg K, Zimmermann F, Zwahlen DR, Tsoutsou P, Zilli T. A national survey on radiation oncology patterns of practice in Switzerland during the COVID-19 pandemic: Present changes and future perspectives. Radiother Oncol 2020; 150:1-3. [PMID: 32512075 PMCID: PMC7274968 DOI: 10.1016/j.radonc.2020.05.047] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Abdelkarim S Allal
- Department of Radiation Oncology, Cantonal Hospital of Fribourg - HFR, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland
| | - Brigitta G Baumert
- Department of Radiation Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Karl T Beer
- Radiation Oncology Center, Bienne-Seeland-Jura Bernois, Switzerland
| | - Michael Betz
- Department of Radiation Oncology, Hirslanden Clinique Bois-Cerf, Lausanne, Switzerland
| | - Thomas Breuneval
- Department of Radiation Oncology, Hôpital de La Tour, Geneva, Switzerland
| | - Stephan Bodis
- Department of Radiation Oncology, KSA-KSB, Kantonspital Aarau, Switzerland
| | - Berardino de Bari
- Department of Radiation Oncology, Réseau Hospitalier Neuchâtelois, La Chaux-de-Fonds, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital of Winthertur, Switzerland
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Switzerland
| | - Evelyn Herrmann
- Department of Radiation Oncology, Hôpital Riviera-Chablais, Rennaz, Switzerland
| | - Constance Huck
- Department of Radiation Oncology, Geneva University Hospital, Switzerland
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Hôpital du Valais, Sion, Switzerland
| | - Oscar Matzinger
- Department of Radiation Oncology, Clinique de Genôlier - Centre Médical des Eaux Vives, Geneva, Switzerland
| | - Nicolas Peguret
- Department of Radiation Oncology, Hirslanden Clinique Grangettes, Geneva, Switzerland
| | - Gianfranco Pesce
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Paul M Putora
- Department of Radiation Oncology, Cantonal Hospital of St. Gallen, St. Gallen and Department of Radiation Oncology, University of Bern, Switzerland
| | - Christiane Reuter
- Department of Radiation Oncology, Spital Thurgau AG, Kantonsspitäler Frauenfeld und Münsterlingen, Switzerland
| | - Antonella Richetti
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Hansjörg Vees
- Radiotherapy Institute, Hirslanden Klinik, Zürich, Switzerland
| | - Conny Vrieling
- Department of Radiation Oncology, Hirslanden Clinique Grangettes, Geneva, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Triemli, Zürich and Department of Radiation Oncology, University of Bern, Switzerland
| | - Frank Zimmermann
- Department of Radiation Oncology, University Hospital Basel, Switzerland
| | - Daniel R Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winthertur, Switzerland
| | - Pelagia Tsoutsou
- Department of Radiation Oncology, Geneva University Hospital, Switzerland; Faculty of Medicine, Geneva University, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Switzerland; Faculty of Medicine, Geneva University, Switzerland.
| |
Collapse
|
31
|
Paterson C, Gobel B, Gosselin T, Haylock PJ, Papadopoulou C, Slusser K, Rodriguez A, Pituskin E. Oncology Nursing During a Pandemic: Critical Reflections in the Context of COVID-19. Semin Oncol Nurs 2020; 36:151028. [PMID: 32423833 PMCID: PMC7177078 DOI: 10.1016/j.soncn.2020.151028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic. DATA SOURCES Electronic databases, including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar. CONCLUSION Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse. IMPLICATIONS FOR NURSING PRACTICE It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.
Collapse
Affiliation(s)
- Catherine Paterson
- University of Canberra, ACT, Australia; Canberra Health Services, ACT, Australia.
| | | | | | | | - Constantina Papadopoulou
- University of the West of Scotland School of Health Nursing and Midwifery, Hamilton, South Lanarkshire, UK
| | - Kim Slusser
- Smilow Cancer Hospital, Yale New Haven Hospital, New Haven, CT, USA
| | - Anna Rodriguez
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | |
Collapse
|
32
|
Rathod S, Dubey A, Chowdhury A, Bashir B, Koul R. A Call for a Radiation Oncology Model Based on New 4R's During the COVID-19 Pandemic. Adv Radiat Oncol 2020; 5:608-609. [PMID: 32363246 PMCID: PMC7195347 DOI: 10.1016/j.adro.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Shrinivas Rathod
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amitava Chowdhury
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
33
|
Starling MTM, Silva ARNDSE, Pereira APA, Ferreira Neto DR, Restini FCF, Brito LHD, Souza TYTD, Hanna SA. Recommendations for radiotherapy during the novel coronavirus pandemic. Rev Assoc Med Bras (1992) 2020; 66:359-365. [PMID: 32520158 DOI: 10.1590/1806-9282.66.3.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Samir Abdallah Hanna
- . Médico titular do departamento de Radio-oncologia do Hospital Sírio-Libanês, São Paulo Brasil . Autor correspondente
| |
Collapse
|