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Calvo FA, Palma J, Serrano J, Cambeiro M, Meiriño R, Martin S, Azcona D, Pedrero D, Aguilar B, Delgado JM, Moran V, Viñals A, Cabello P, Panizo E, Lassaletta A, Gibert C, Sancho L, de Miguel JMF, de Sierra BA, Alcázar A, Suarez V, Alonso A, Gallardo G, Aristu J. Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution. Clin Transl Oncol 2023; 25:1268-1276. [PMID: 36961726 PMCID: PMC10036962 DOI: 10.1007/s12094-023-03127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.
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Affiliation(s)
- Felipe A Calvo
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain.
| | - Jacobo Palma
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Serrano
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Mauricio Cambeiro
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Rosa Meiriño
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Santiago Martin
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Azcona
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Diego Pedrero
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Borja Aguilar
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Jose Miguel Delgado
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Verónica Moran
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alberto Viñals
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Pablo Cabello
- Department of Medical Physics and Radioprotection, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Elena Panizo
- Department of Pediatric Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alvaro Lassaletta
- Department of Pediatric Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Carlota Gibert
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Lidia Sancho
- Department of Nuclear Medicine, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | | | | | - Andres Alcázar
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Victor Suarez
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Alberto Alonso
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Guillermo Gallardo
- Department of Radiology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
| | - Javier Aristu
- Department of Radiation Oncology, Cancer Center, Clinica Universidad de Navarra, Madrid, Spain
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De B, Fu S, Chen Y, Das P, Ku K, Maroongroge S, Woodhouse KD, Hoffman KE, Nguyen Q, Reed VK, Chen AB, Koong AC, Smith BD, Smith GL. Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care. Cancer Med 2022; 11:2096-2105. [PMID: 35297210 PMCID: PMC9119354 DOI: 10.1002/cam4.4555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Oncology telemedicine was implemented rapidly after COVID-19. We examined multilevel correlates and outcomes of telemedicine use for patients undergoing radiotherapy (RT) for cancer. METHODS Upon implementation of a telemedicine platform at a comprehensive cancer center, we analyzed 468 consecutive patient RT courses from March 16, 2020 to June 1, 2020. Patients were categorized as using telemedicine during ≥1 weekly oncologist visits versus in-person oncologist management only. Temporal trends were evaluated with Cochran-Armitage tests; chi-squared test and multilevel multivariable logistic models identified correlates of use and outcomes. RESULTS Overall, 33% used telemedicine versus 67% in-person only oncologist management. Temporal trends (ptrend < 0.001) correlated with policy changes: uptake was rapid after local social-distancing restrictions, reaching peak use (35% of visits) within 4 weeks of implementation. Use declined to 15% after national "Opening Up America Again" guidelines. In the multilevel model, patients more likely to use telemedicine were White non-Hispanic versus Black or Hispanic (odds ratio [OR] = 2.20, 95% confidence interval [CI] 1.03-4.72; p = 0.04) or receiving ≥6 fractions of RT versus 1-5 fractions (OR = 4.49, 95% CI 2.29-8.80; p < 0.001). Model intraclass correlation coefficient demonstrated 43% utilization variation was physician-level driven. Treatment toxicities and 30-day emergency visits or unplanned hospitalizations did not differ for patients using versus not using telemedicine (p > 0.05, all comparisons). CONCLUSION Though toxicities were similar with telemedicine oncology management, there remained lower uptake among non-White patients. Continuing strategies for oncology telemedicine implementation should address multilevel patient, physician, and policy factors to optimize telemedicine's potential to surmount-and not exacerbate-barriers to quality cancer care.
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Affiliation(s)
- Brian De
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Shuangshuang Fu
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ying‐Shiuan Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Prajnan Das
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kimberly Ku
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Sean Maroongroge
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Kristina D. Woodhouse
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Karen E. Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Quynh‐Nhu Nguyen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Valerie K. Reed
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Aileen B. Chen
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Albert C. Koong
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Benjamin D. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Grace L. Smith
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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3
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Jensen K, Dalby RB, Bouchelouche K, Pedersen EM, Kalmar S. Telehealth in Multidisciplinary Target Delineation for Radiotherapy During the COVID-19 Pandemic. A Review and a Case. Semin Nucl Med 2022; 52:79-85. [PMID: 34217435 PMCID: PMC8206582 DOI: 10.1053/j.semnuclmed.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Like all other medical specialties, radiotherapy has been deeply influenced by the COVID-19 pandemic. The pandemic has had severe influence on the entire patient trajectory in oncology, from diagnosis to treatment and follow-up. Many examples of how to deal with patient and staff safety, shortness of staff and other resources and the quest to continue high-quality, evidence-based treatment have been presented. The use of telemedicine and telehealth is frequently presented as a part of the solution to overcome these challenges. Some of the available presented solutions will only apply in an acute, local setting, whereas others might inspire the community to improve quality and cost-effectiveness of radiotherapy as well as knowledge sharing in the future. Some of the unresolved issues in many of the available technical solutions are related to data security and public regulation, for example, GDPR (General Data Protection Regulation) in the EU and HIPAA compliance (Health Insurance Portability and Accountability Act) in the USA. Using a solution that involves a supplier's server in a non-EU country is problematic within the EU. In this paper we shortly review the influence of COVID-19 on radiotherapy. We describe some of the possible solutions for telehealth in target delineation - a crucial part of high-quality radiotherapy, which often requires multidisciplinary effort, hands-on corporation, and high-quality multimodal imaging. Hereafter, our own technical solution will be presented as a case.
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Affiliation(s)
- Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark,Address reprint requests to: Kenneth Jensen MD, PhD, Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Denmark
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Augustyn A, Reed VI, Ahmad N, Bhutani MS, Bloom ES, Bowers JR, Chronowski GM, Das P, Holliday EB, Delclos ME, Huey RW, Koay EJ, Lee SS, Nelson CL, Taniguchi CM, Koong AC, Chun SG. Implementation of a stereotactic body radiotherapy program for unresectable pancreatic cancer in an integrated community academic radiation oncology satellite network. Clin Transl Radiat Oncol 2021; 27:147-151. [PMID: 33665384 PMCID: PMC7907676 DOI: 10.1016/j.ctro.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Abstract
PDSA methodology was used to implement a pancreas SBRT in an academic satellite network. Oncologic outcomes were favorable with no serious adverse events. This technical note provides groundwork for safe establishment of SBRT pancreas programs.
With increasing interest in stereotactic body radiotherapy (SBRT) for unresectable pancreatic cancer, quality improvement (QI) initiatives to develop integrated clinical workflows are crucial to ensure quality assurance (QA) when introducing this challenging technique into radiation practices. Materials/Methods: In 2017, we used the Plan, Do, Study, Act (PDSA) QI methodology to implement a new pancreas SBRT program in an integrated community radiation oncology satellite. A unified integrated information technology infrastructure was used to virtually integrate the planned workflow into the community radiation oncology satellite network (P – Plan/D – Do). This workflow included multiple prospective quality assurance (QA) measures including multidisciplinary evaluation, prospective scrutiny of radiation target delineation, prospective radiation plan evaluation, and monitoring of patient outcomes. Institutional review board approval was obtained to retrospectively study and report outcomes of patients treated in this program (S – Study). Results: There were 12 consecutive patients identified who were treated in this program from 2017 to 2020 with a median follow-up of 27 months. The median survival was 13 months, median local failure free survival was 12 months and median progression free survival was 6 months from SBRT. There were no acute or late Common Terminology Criteria for Adverse Effects (CTCAE) version 5 toxicities ≥ Grade 3. Conclusion: We report the successful implementation of a community pancreas SBRT program involving multiple prospective QA measures, providing the groundwork to safely expand access to pancreas SBRT in our community satellite network (A – Act).
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Affiliation(s)
- Alexander Augustyn
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Valerie I. Reed
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Neelofur Ahmad
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth S. Bloom
- Department of Gastroenterology, Hepatology and Nutrition, Division of Internal Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - John R. Bowers
- Department of Radiation Oncology, M.D. Anderson Albuquerque, Albuquerque, NM, United States
| | - Gregory M. Chronowski
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Prajnan Das
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Emma B. Holliday
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Marc E. Delclos
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Ryan W. Huey
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Eugene J. Koay
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sunyoung S. Lee
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Christopher L. Nelson
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Cullen M. Taniguchi
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Albert C. Koong
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
| | - Stephen G. Chun
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, United States
- Corresponding author.
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De B, Kaiser KW, Ludmir EB, Yeboa DN, Tang C, Hoffman KE, Liao Z, Koong AC, Smith BD. Radiotherapy clinical trial enrollment during the COVID-19 pandemic. Acta Oncol 2021; 60:312-315. [PMID: 33356801 DOI: 10.1080/0284186x.2020.1865564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Brian De
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelsey W. Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan B. Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra N. Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Albert C. Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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McGovern SL, Wages C, Dimmitt A, Sanders C, Martin D, Ning MS, Manning R, Amin M, Zhu XR, Frank SJ, Gunn GB. Proton Therapy in a Pandemic: An Operational Response to the COVID-19 Crisis. Int J Part Ther 2020; 7:54-57. [PMID: 33094136 PMCID: PMC7574828 DOI: 10.14338/ijpt-20-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cody Wages
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Dimmitt
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Sanders
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deanna Martin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew S Ning
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rochelle Manning
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mayank Amin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Ronald Zhu
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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Hoffman KE. Wait and Hurry Up: Radiation Therapy for Prostate Cancer During the COVID-19 Pandemic. Int J Radiat Oncol Biol Phys 2020; 108:340. [PMID: 32890505 PMCID: PMC7462868 DOI: 10.1016/j.ijrobp.2020.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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8
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Esfahani SA, Lee A, Hu JY, Kelly M, Magudia K, Everett C, Szabunio M, Ackerman S, Spalluto LB. Challenges faced by women in radiology during the pandemic - A summary of the AAWR Women's Caucus at the ACR 2020 annual meeting. Clin Imaging 2020; 68:291-294. [PMID: 32957024 PMCID: PMC7453221 DOI: 10.1016/j.clinimag.2020.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has dramatically altered the professional and personal lives of radiologists and radiation oncologists. This article summarizes the 2020 American Association for Women in Radiology (AAWR) Women's Caucus at the American College of Radiology (ACR) Annual Meeting. The caucus focused on the major challenges that women in radiology have faced during the pandemic.
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Affiliation(s)
- Shadi A Esfahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anna Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jiun-Yiing Hu
- Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, United States
| | - Maria Kelly
- Department of Radiation Oncology, VA New Jersey Health Care System, East Orange, NJ, United States
| | - Kirti Magudia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | | | - Margaret Szabunio
- Department of Radiology, University of Kentucky, Lexington, KY, United States
| | - Susan Ackerman
- Department of Radiology, Medical University of South Carolina, Charleston, SC, United States
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Ingram Cancer Center, Nashville, TN, United States; Veterans' Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, TN, United States.
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9
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Ning MS, McAleer MF, Jeter MD, Minsky BD, Ghafar RA, Robinson IJ, Nitsch PL, Zaebst DJ, Todd SE, Nguyen J, Lin SH, Liao Z, Lee P, Gunn GB, Klopp AH, Dabaja BS, Nguyen QN, Chronowski GM, Bloom ES, Koong AC, Das P. Mitigating the impact of COVID-19 on oncology: Clinical and operational lessons from a prospective radiation oncology cohort tested for COVID-19. Radiother Oncol 2020; 148:252-257. [PMID: 32474129 PMCID: PMC7256609 DOI: 10.1016/j.radonc.2020.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines. MATERIALS AND METHODS Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). RESULTS A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to ≤1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75-5) to 1 business day (IQR: 1-2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3-6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2-11), with a peak of 17 employees simultaneously quarantined. Following implementation of a "dual PPE policy," newly quarantined employees decreased from 2.9 to 0.5 per day. CONCLUSION The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.
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Affiliation(s)
- Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Melenda D Jeter
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Robert A Ghafar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ivy J Robinson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Paige L Nitsch
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Denise J Zaebst
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sarah E Todd
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jennifer Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Percy Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Bouthaina S Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Elizabeth S Bloom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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10
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Samson P, Ning MS, Shaverdian N, Shepherd AF, Gomez DR, McGinnis GJ, Nitsch PL, Chmura S, O’Reilly MS, Lee P, Chang JY, Robinson C, Lin SH. Clinical and Radiographic Presentations of COVID-19 Among Patients Receiving Radiation Therapy for Thoracic Malignancies. Adv Radiat Oncol 2020; 5:700-704. [PMID: 32395673 PMCID: PMC7212983 DOI: 10.1016/j.adro.2020.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/23/2020] [Accepted: 04/27/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Matthew S. Ning
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annemarie F. Shepherd
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Paige L. Nitsch
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Steven Chmura
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | | | - Percy Lee
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Joe Y. Chang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Steven H. Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
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