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Smile InTM Totems in Radiotherapy: Patients’ Satisfaction with Limited Equipment and COVID-19. Healthcare (Basel) 2022; 10:healthcare10081533. [PMID: 36011190 PMCID: PMC9408583 DOI: 10.3390/healthcare10081533] [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: 07/09/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: We report a mono-institutional experience regarding patient-perceived quality regarding the Chieti Radiotherapy Department, through RAMSI (Radiotherapy Amica Mia—SmileINTM(SI)—My Friend RadiotherapySI) project, in critical scenarios of limited equipment and COVID-19. Material and methods: Patient-reported experience measures (PREMs) were assessed as follows: Patient-centric welcome perception (PCWP), Comfort, Professional skills and Punctuality. Patients could give anonymous feedback using HappyOrNot technology through four totems located in strategic areas within the center. An internal benchmark was obtained using the feedback received after a preliminary observation period. The SI Experience Index was collected, analyzed and compared. Weekly and monthly reports were generated. Results: From February 2019 to February 2022, 8924 patients accessed the department; 17,464 daily treatments were recorded and 5830 points of feedback were collected: 896, 1267, 1125 and 2542 for PCWP, Comfort, Professional skills and Punctuality, respectively. A LINAC decommissioning period was analyzed, with decreases in the SI-Index score and Smile-IN approved percentage and an improvement after this period. Additionally, the COVID-19 pandemic was analyzed with a mild evaluations decrease for PREM’s Welcome, Comfort and Punctuality (Δ-value: −9%, −3% and −4%, respectively), while Professional skills were always optimal. Conclusion: The RAMSI project was effective for assessing treatment quality perception, allowing for improving clinical procedures with corrective actions. The RAMSI project is ongoing.
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Rahmadhan MA, Parenrengi MA, Suryaningtyas W. A Case Report of Pediatric Germinoma With SARS-CoV-2: Lessons Learned From an Academic Tertiary Referral Hospital in Asian COVID Epicentrum. Int J Surg Case Rep 2022; 91:106774. [PMID: 35070644 PMCID: PMC8762814 DOI: 10.1016/j.ijscr.2022.106774] [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: 09/03/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients often present with one or more pre-existing underlying chronic diseases that will affect their prognoses and mortality. A study revealed that the majority of children with SARS-CoV-2 infection presented with either no or a single symptom. Meanwhile, multiple other studies reported of more severe diseases in SARS-CoV-2 infected children with brain tumor and/or cancer as a whole. Case report The patient was a 15-year-old male who was referred to our hospital with complaints of vomiting, headache, and signs of worsening right hemiparesis. Initial MRI suggested of a high-grade astrocytoma and hydrocephalus, but a subtotal tumor resection and external ventricular drainage gave light to a histopathological examination conclusive of germinoma. After adhering to radiotherapy and recovering well, the patient fell into unconsciousness 9 months later and tested positive for SARS-CoV-2 infection. The patient deteriorated on the third day of admission with respiratory failure, shock, arrythmias, fever, and increased d-dimer. After multiple attempts stabilization with ventilatory, defibrillator, and medical support, the patient deceased at the 6th day of admission. Discussion Cancer patients with COVID-19 have been reported to have relatively higher mortality rate when compared to the non-infected patients. Moreover, malignancies were also reported to increase the risk of developing more severe disease in children. Although rare, patients may develop a condition called multisystem inflammatory syndrome in children (MIS-C), which is a state of hyperinflammatory and severe illness temporally associated with COVID-19 infection. No observations have been evident in indicating the influence of COVID-19 on the neurological state of the patient, but we believe that it may be reasonable to not yet exclude the possibility of it of exacerbating the CNS malignancy our patient suffered from. Conclusion Children with intracranial brain tumor infected by SARS-CoV-2 may fall into a worse condition with poor prognosis, exacerbated by severe acute respiratory distress and the need for breathing support in intensive care unit. Multidisciplinary tumor boards have to convene regularly, including through call-conferences and telemedicine platforms. Patient with history of resection of tumor germinoma Covid status of the patient Mortality of the patient caused by covid status Complications of the patient that cannot over come
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Affiliation(s)
- Mustaqim Apriyansa Rahmadhan
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - M Arifin Parenrengi
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Dr. Soetomo Academic General Hospital - Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
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3
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Chuang WK, Cheng SHC, Hung CF, Huang TT, Jen CW, Yen JH, Tsai YC. Comparison between the use of hypofractionated and conventionally fractionated radiotherapy in early breast cancer: A single-center real-world study in Taiwan. J Formos Med Assoc 2022; 121:1588-1595. [DOI: 10.1016/j.jfma.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/24/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022] Open
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4
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Beddok A, Chevrier M, Calugaru V, Minsat M, Dendale R, Lantz O, Servois V, Paoletti X, Crehange G. Acute and late toxicities of patients infected with SARS-CoV-2 and treated for cancer with radiation therapy during the COVID-19 pandemic. Int J Radiat Biol 2021; 97:1436-1440. [PMID: 34269644 DOI: 10.1080/09553002.2021.1956008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aimed to assess the risk of acute and late radiation-induced toxicity in patients with COVID-19. MATERIAL AND METHODS All the patients irradiated in Institut Curie from March to July 2020 were included if the first symptoms related to COVID-19 occurred no more than two months before the start of radiation therapy (RT) or 15 days after the end of RT. RESULTS Twenty-nine patients were included in this analysis. Twenty-five patients had no co-morbidities (86.2%), including morbid obesity. The diagnosis of COVID-19 infection was based on a positive SARS-CoV-2 RNA test for 18 patients (62.1%), a positive serology test for three patients (10.3%), and/or radiologic findings for 12 patients (41.4%). Three patients with symptoms highly suggestive of COVID-19 were included, although they had negative biologic tests and did not have a chest CT scan. Median time from the diagnosis of COVID-19 to the onset of RT was 5.5 days. Modification of RT course due to COVID-19 status was observed in 15 patients, including four for whom RT was definitively stopped. Six patients needed hospitalization for hypoxemic lung disease requiring intensive care. The majority of patients did not experience severe (> grade 2) acute toxicity. After a median follow-up of 6 months (IQR, 1-9 months), none of the patients had unusual clinical or radiological late toxicities. CONCLUSION The observed acute and late toxicities were ultimately similar to those observed in a population not infected with COVID-19. These results do not prompt modification of standard RT protocols for irradiation of COVID-19 patients.
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Affiliation(s)
- Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Marion Chevrier
- Department of Statistics, Institut Curie, Saint-Cloud, France
| | | | - Mathieu Minsat
- Department of Radiation Oncology, Institut Curie, Saint-Cloud, France
| | - Rémi Dendale
- Department of Radiation Oncology. Proton Therapy Center, Institut Curie, Orsay, France
| | - Olivier Lantz
- Department of Immunotherapy, Institut Curie, Paris, France
| | | | - Xavier Paoletti
- Department of Statistics, Institut Curie, Saint-Cloud, France
| | - Gilles Crehange
- Department of Radiation Oncology, Institut Curie, Paris, France
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5
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Zietman AL, Yom SS. The Red Journal's Top Downloaded Articles in 2020. Int J Radiat Oncol Biol Phys 2021; 110:928-930. [PMID: 33849737 DOI: 10.1016/j.ijrobp.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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6
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Corrao G, Bergamaschi L, Zaffaroni M, Cavallo I, Marvaso G, Alterio D, Mastrilli F, Capizzi S, Desideri I, Pravettoni G, Orecchia R, Jereczek-Fossa BA. COVID-19 and radiotherapy: impact on work and personal life of Lombardy residents during first lockdown, survey endorsed by AIRO Young. TUMORI JOURNAL 2021; 108:172-176. [PMID: 33730961 DOI: 10.1177/03008916211000826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM Since 20 February 2020, Lombardy has been one of the most affected areas worldwide by the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to evaluate work and psychological impact of COVID-19 on Lombardy radiation therapy (RT) residents in the first 3 months of the outbreak (first lockdown). METHODS An online questionnaire (22 multiple choice questions) via Microsoft Forms was administered on 30 May 2020 to RT residents. RESULTS Nineteen Lombardy RT residents responded to the survey. Nineteen percent of residents underwent a nasal swab and 11% were quarantined. Seventeen residents (89%) reported an increase in workload. Twelve residents (63%) did not find any difference in terms of work distress; worsening was highlighted in 5 cases (26%). The majority has never considered the possibility of stopping work due to excessive stress (89%). Almost all the residents experienced self- or relative-referred apprehension (95%). Ninety-five percent reported having missed extra-work social relationships. Most of the sample noted worsening sleep quality and difficulty concentrating (69%). No residents requested psychological support, even if provided by the hospital. CONCLUSION Overall, the residents adapted to the new workplace scenario, although some health risks and well-being challenges have been reported. An extension of the survey to all Italian RT residents endorsed by Italian Association of Radiotherapy and Clinical Oncology "Young AIRO" will allow an evaluation of COVID-19 impact on a national level. A second survey is planned to underline differences between the first lockdown and the current situation of the pandemic.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luca Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Iacopo Cavallo
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, 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
| | - Fabrizio Mastrilli
- Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Italy
| | - Silvio Capizzi
- Medical Administration, CMO, IEO, European Institute of Oncology, IRCCS, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," Section of Radiation Oncology, University of Florence, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, 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
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7
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Teckie S, Andrews JZ, Chen WCY, Goenka A, Koffler D, Adair N, Potters L. Impact of the COVID-19 Pandemic Surge on Radiation Treatment: Report From a Multicenter New York Area Institution. JCO Oncol Pract 2021; 17:e1270-e1277. [PMID: 33529045 DOI: 10.1200/op.20.00619] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE During the COVID-19 surge months of March and April 2020, our New York multicenter health system experienced an influx of cases with COVID-19. We sought to study the impact of the surge period on patients with cancer prescribed radiation treatment (RT). METHODS We reviewed our secure departmental quality assurance database for all patients who underwent RT planning simulations from March 6, 2020, through April 30, 2020. A priority level between 1 and 3 was prospectively assigned to each case based on faculty consensus to determine which patients required immediate RT. In May 2020, each faculty physician again retrospectively reviewed their patients from the database and provided additional commentary on how the COVID-19 pandemic had affected each patient's care. All statistics are descriptive. RESULTS A total of 412 RT courses in 406 unique patients were simulated for linear accelerator-based external beam RT. The median age was 66 years. Treatment intent was curative in 70.6% and palliative in 29.4%. Of the 412 cases, 66.7% were priority 1, 25% priority 2, and 7.8% priority 3. Two hundred thirty-nine cases (58%) underwent standard-of-care diagnosis, workup, and treatment plan. Seventeen patients (4.1%) electively canceled their RT, and 17 others (4.1%) electively delayed RT start. Thirty-four (8.3%) were prescribed hypofractionation to shorten their RT course, and 22 (5.3%) had a change in modality. Incomplete or delayed workup was identified in 19 cases (4.6%). CONCLUSION The COVID-19 pandemic surge resulted in 42% of our patients having a non-standard-of-care pathway. This outcome demonstrates a significant impact of the COVID-19 crisis on routine cancer care.
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Affiliation(s)
- Sewit Teckie
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Janna Zeola Andrews
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - William Chun-Ying Chen
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Anuj Goenka
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Daniel Koffler
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Nilda Adair
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
| | - Louis Potters
- Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.,Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY
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8
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Barra S, Guarnieri A, di Monale E Bastia MB, Marcenaro M, Tornari E, Belgioia L, Magrini SM, Ricardi U, Corvò R. Short fractionation radiotherapy for early prostate cancer in the time of COVID-19: long-term excellent outcomes from a multicenter Italian trial suggest a larger adoption in clinical practice. LA RADIOLOGIA MEDICA 2021; 126:142-146. [PMID: 32415472 PMCID: PMC7227177 DOI: 10.1007/s11547-020-01216-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate stereotactic body radiotherapy (SBRT) in low-risk Prostate Cancer patients as preferred treatment option in emergency health conditions. MATERIALS AND METHODS From April 2013 to September 2015, 28 patients with low-risk prostate cancer were prospectively enrolled. The SBRT prescribed dose was 36.25 Gy in 5 fractions, twice a week. Primary endpoints were acute and late toxicity. Secondary endpoints were biochemical recurrence free survival (bRFS) and overall survival. RESULTS Median follow-up was 65.5 months (range 52-81). No acute G3 or G4 toxicity was recorded. Acute G1 or G2 genitourinary (GU) toxicity occurred in 43% and acute G1-G2 gastrointestinal (GI) toxicity in 14%. Late G1 and G3 GU toxicity in 18% and 3.5%, respectively. The G3 toxicity was not directly attributable to radiotherapy. Late G1 GI toxicity occurred in 18%. 5yy bRFS was 96.5% (95% CI 82.3-99.4%). CONCLUSIONS Stereotactic body radiotherapy for early prostate cancer reported safe toxicity profile and a good clinical outcome at the median follow-up of 5 years. It may be an useful option if radiotherapy is required in emergency medical conditions.
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Affiliation(s)
- Salvina Barra
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessia Guarnieri
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | | | - Michela Marcenaro
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elena Tornari
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy
| | - Liliana Belgioia
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy.
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - Umberto Ricardi
- Radiation Oncology Department AO Città della Salute e della Scienza - Molinette, University of Turin, Turin, Italy
| | - Renzo Corvò
- Radiation Oncology Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Health Science Department (DISSAL), University of Genoa, Genoa, Italy
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9
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Rao A, Mohan F. Study of effect of Corona-19 pandemic on radiation oncology practice – Single institution experience. JOURNAL OF RADIATION AND CANCER RESEARCH 2021. [DOI: 10.4103/jrcr.jrcr_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Deantonio L, Bosetti D, Cima S, Martucci F, Borgonovo G, Di Bella G, Pesce GA, Valli M, Richetti A. #Stayathome: Smart working for radiation oncologists during the corona pandemic. Strahlenther Onkol 2020; 196:1094-1095. [PMID: 32945893 PMCID: PMC7499407 DOI: 10.1007/s00066-020-01683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Letizia Deantonio
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland.
| | - Davide Bosetti
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Simona Cima
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Giulia Borgonovo
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Gianluca Di Bella
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Gianfranco Angelo Pesce
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Mariacarla Valli
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
| | - Antonella Richetti
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland (IOSI), Bellinzona-Lugano, Via Gallino, 6500, Bellinzona, Switzerland
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11
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Svajdova M, Sicak M, Dubinsky P, Slavik M, Slampa P, Kazda T. Recurrent Nasopharyngeal Cancer: Critical Review of Local Treatment Options Including Recommendations during the COVID-19 Pandemic. Cancers (Basel) 2020; 12:cancers12123510. [PMID: 33255751 PMCID: PMC7760235 DOI: 10.3390/cancers12123510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Options for the curative treatment of locally recurrent nasopharyngeal carcinoma include surgery or re-irradiation. Both approaches have been scientifically explored, yet there is no consensus on the indication or definitive preference of the above two salvage treatments. The aim of this review is to summarize the current evidence on the local treatment of recurrent nasopharyngeal carcinoma. The feasibility, safety, and efficacy of salvage surgery and radical re-irradiation are discussed. Recommendations on treatment modifications during the coronavirus disease 2019 pandemic are included as well. Abstract Recurrent nasopharyngeal carcinoma represents an extremely challenging therapeutic situation. Given the vulnerability of the already pretreated neurological structures surrounding the nasopharynx, any potential salvage retreatment option bears a significant risk of severe complications that result in high treatment-related morbidity, quality of life deterioration, and even mortality. Yet, with careful patient selection, long-term survival may be achieved after local retreatment in a subgroup of patients with local or regional relapse of nasopharyngeal cancer. Early detection of the recurrence represents the key to therapeutic success, and in the case of early stage disease, several curative treatment options can be offered to the patient, albeit with minimal support in prospective clinical data. In this article, an up-to-date review of published evidence on modern surgical and radiation therapy treatment options is summarized, including currently recommended treatment modifications of both therapeutic approaches during the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Michaela Svajdova
- Department of Radiation and Clinical Oncology, Central Military Hospital—Teaching Hospital Ruzomberok, 034 01 Ruzomberok, Slovakia
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Correspondence: ; Tel.: +421-911-618-265
| | - Marian Sicak
- Department of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital—Teaching Hospital, 034 01 Ruzomberok, Slovakia;
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, 041 91 Kosice, Slovakia;
- Faculty of Health, Catholic University Ruzomberok, 034 01 Ruzomberok, Slovakia
| | - Marek Slavik
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic;
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic; (P.S.); (T.K.)
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12
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Investigating the Benefit of Combined Androgen Modulation and Hypofractionation in Prostate Cancer. Int J Mol Sci 2020; 21:ijms21228447. [PMID: 33182844 PMCID: PMC7698244 DOI: 10.3390/ijms21228447] [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: 09/09/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
Hypofractionation is currently considered a valid alternative to conventional radiotherapy for the treatment of patients with organ-confined prostate cancer. Recent data have demonstrated that extreme hypofractionation, which involves the use of a high radiation dose per delivered fraction and concomitant reduction of sessions, is a safe and effective treatment, even though its radiobiological rationale is still lacking. The present work aims to investigate the biological basis sustaining this approach and to evaluate the potential of a hypofractionated regimen in combination with androgen deprivation therapy, one of the major standards of care for prostate cancer. Findings show that androgen receptor (AR) modulation, by use of androgens and antiandrogens, has a significant impact on cell survival, especially in hypoxic conditions (4% O2). Subsequent experiments have revealed that AR activity as a transcription factor is involved in the onset of malignant senescence-associated secretory phenotype (SASP) and activation of DNA repair cascade. In particular, we found that AR stimulation in hypoxic conditions promotes the enhanced transcription of ATM gene, the cornerstone kinase of the DNA damage repair genes. Together, these data provide new potential insights to justify the use of androgen deprivation therapy, in particular with second-generation anti-androgens such as enzalutamide, in combination with radiotherapy.
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13
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Management of a radiation oncology clinic in a clean oncology hospital during the COVID-19 outbreak. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.780806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Boon IS, Lim JS, Au Yong TPT, Boon CS. Digital healthcare and shifting equipoise in radiation oncology: The butterfly effect of the COVID-19 pandemic. J Med Imaging Radiat Sci 2020; 52:11-13. [PMID: 33097437 PMCID: PMC7575423 DOI: 10.1016/j.jmir.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Ian S Boon
- Department of Clinical Oncology, Leeds Cancer Centre, St James's Institute of Oncology, Leeds, United Kingdom.
| | - Jean S Lim
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Tracy P T Au Yong
- Department of Radiology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, United Kingdom
| | - Cheng S Boon
- Department of Clinical Oncology, The Clatterbridge Cancer Centre, Wirral, United Kingdom
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15
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Sogono P, Bressel M, David S, Shaw M, Chander S, Chu J, Plumridge N, Byrne K, Hardcastle N, Kron T, Wheeler G, Hanna GG, MacManus M, Ball D, Siva S. Safety, Efficacy, and Patterns of Failure After Single-Fraction Stereotactic Body Radiation Therapy (SBRT) for Oligometastases. Int J Radiat Oncol Biol Phys 2020; 109:756-763. [PMID: 33069796 PMCID: PMC7560377 DOI: 10.1016/j.ijrobp.2020.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/07/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022]
Abstract
Purpose Fewer attendances for radiation therapy results in increased efficiency and less foot traffic within a radiation therapy department. We investigated outcomes after single-fraction (SF) stereotactic body radiation therapy (SBRT) in patients with oligometastatic disease. Methods and Materials Between February 2010 and June 2019, patients who received SF SBRT to 1 to 5 sites of oligometastatic disease were included in this retrospective study. The primary objective was to describe patterns of first failure after SBRT. Secondary objectives included overall survival (OS), progression-free survival (PFS), high-grade treatment-related toxicity (Common Terminology Criteria for Adverse Events grade ≥3), and freedom from systemic therapy (FFST). Results In total, 371 patients with 494 extracranial oligometastases received SF SBRT ranging from 16 Gy to 28 Gy. The most common primary malignancies were prostate (n = 107), lung (n = 63), kidney (n = 52), gastrointestinal (n = 51), and breast cancers (n = 42). The median follow-up was 3.1 years. The 1-, 3-, and 5-year OS was 93%, 69%, and 55%, respectively; PFS was 48%, 19%, and 14%, respectively; and FFST was 70%, 43%, and 35%, respectively. Twelve patients (3%) developed grade 3 to 4 treatment-related toxicity, with no grade 5 toxicity. As the first site of failure, the cumulative incidence of local failure (irrespective of other failures) at 1, 3 and 5 years was 4%, 8%, and 8%, respectively; locoregional relapse at the primary was 10%, 18%, and 18%, respectively; and distant failure was 45%, 66%, and 70%, respectively. Conclusions SF SBRT is safe and effective, and a significant proportion of patients remain FFST for several years after therapy. This approach could be considered in resource-constrained or bundled-payment environments. Locoregional failure of the primary site is the second most common pattern of failure, suggesting a role for optimization of primary control during metastasis-directed therapy.
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Affiliation(s)
- Paolo Sogono
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steven David
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mark Shaw
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nikki Plumridge
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Keelan Byrne
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Greg Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gerard G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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16
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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.
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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
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17
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Recommendations on Management of Locally Advanced Rectal Cancer During the COVID-19 Pandemic: an Iranian Consensus. J Gastrointest Cancer 2020; 51:800-804. [PMID: 32656628 PMCID: PMC7355082 DOI: 10.1007/s12029-020-00454-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. Methods In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. Results We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. Conclusion Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.
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18
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Ahmed MK, Afifi M, Uskoković V. Protecting healthcare workers during COVID-19 pandemic with nanotechnology: A protocol for a new device from Egypt. J Infect Public Health 2020; 13:1243-1246. [PMID: 32798183 PMCID: PMC7396966 DOI: 10.1016/j.jiph.2020.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 12/21/2022] Open
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to have occurred first in Wuhan, China in December 2019, before spreading to over 120 countries in the months that followed. It was declared a “public health emergency of international concern” by the World Health Organization on January 31, 2020 and recognized as a pandemic on March 11, 2020. The primary route of SARS-CoV-2 transmission from human to human is through inhalation of respiratory droplets. Devising protective technologies for stopping the spread of the droplets of aerosol containing the viral particles is a vital requirement to curb the ongoing outbreak. However, the current generations of protective respirator masks in use are noted for their imperfect design and there is a need to develop their more advanced analogues, with higher blockage efficiency and the ability to deactivate the trapped bacteria and viruses. It is likely that one such design will be inspired by nanotechnologies. Here we describe a new design from Egypt, utilizing a reusable, recyclable, customizable, antimicrobial and antiviral respirator facial mask feasible for mass production. The novel design is based on the filtration system composed of a nanofibrous matrix of polylactic acid and cellulose acetate containing copper oxide nanoparticles and graphene oxide nanosheets and produced using the electrospinning technique. Simultaneously, the flat pattern fabricated from a thermoplastic composite material is used to provide a solid fit with the facial anatomy. This design illustrates an effort made in a developing setting to provide innovative solutions for combating the SARS-CoV-2 pandemic of potentially global significance.
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Affiliation(s)
- Mohamed K Ahmed
- Department of Physics, Faculty of Science, Suez University, Suez, Egypt.
| | - Mohamed Afifi
- Ultrasonic Laboratory, National Institute of Standards, Giza, Egypt.
| | - Vuk Uskoković
- TardigradeNano, 7 Park Vista, Irvine, CA 92604, USA.
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Alterio D, Volpe S, Marvaso G, Turturici I, Ferrari A, Leonardi MC, Lazzari R, Fiore MS, Bufi G, Cattani F, Arrobbio C, Patti F, Casbarra A, Cavallo I, Mastrilli F, Orecchia R, Jereczek‐Fossa BA. Head and neck cancer radiotherapy amid COVID-19 pandemic: Report from Milan, Italy. Head Neck 2020; 42:1482-1490. [PMID: 32557972 PMCID: PMC7323327 DOI: 10.1002/hed.26319] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Management of head and neck cancers (HNC) in radiation oncology in the coronavirus disease 2019 (COVID-19) era is challenging. Aim of our work is to report organization strategies at a radiation therapy (RT) department in the first European area experiencing the COVID-19 pandemic. METHODS We focused on (a) dedicated procedures for HNC, (b) RT scheduling, and (c) health care professionals' protection applied during the COVID-19 breakdown (from March 1, 2020 to April 30, 2020). RESULTS Applied procedures are reported and discussed. Forty-three patients were treated. Image-guided, intensity modulated RT was performed in all cases. Median overall treatment time was 50 (interquartile range: 47-54.25) days. RT was interrupted/delayed in seven patients (16%) for suspected COVID-19 infection. Two health professionals managing HNC patients were proven as COVID-19 positive. CONCLUSION Adequate and well-timed organization allowed for the optimization of HNC patients balancing at the best of our possibilities patients' care and personnel's safety.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Stefania Volpe
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Giulia Marvaso
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Irene Turturici
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Annamaria Ferrari
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | | | - Roberta Lazzari
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Massimo Sarra Fiore
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Giammaria Bufi
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
| | - Federica Cattani
- Medical Physics UnitIEO, European Institute of Oncology IRCCSMilanItaly
| | - Camilla Arrobbio
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Filippo Patti
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Alessia Casbarra
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Iacopo Cavallo
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Fabrizio Mastrilli
- Medical Administration, CMOIEO, European Institute of Oncology, IRCCSMilanItaly
| | - Roberto Orecchia
- Scientific DirectionIEO, European Institute of Oncology, IRCCSMilanItaly
| | - Barbara Alicja Jereczek‐Fossa
- Division of Radiation OncologyIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
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20
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Al-Rashdan A, Roumeliotis M, Quirk S, Grendarova P, Phan T, Cao J, Logie N, Smith W, Barbera L. Adapting Radiation Therapy Treatments for Patients with Breast Cancer During the COVID-19 Pandemic: Hypo-Fractionation and Accelerated Partial Breast Irradiation to Address World Health Organization Recommendations. Adv Radiat Oncol 2020; 5:575-576. [PMID: 32363244 PMCID: PMC7194663 DOI: 10.1016/j.adro.2020.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Abdulla Al-Rashdan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Michael Roumeliotis
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Quirk
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Petra Grendarova
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Grand Prairie Cancer Centre, Grand Prairie, Alberta, Canada
| | - Tien Phan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jeffery Cao
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Natalie Logie
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Wendy Smith
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
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21
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Darafsheh A, Lavvafi H, Taleei R, Khan R. Mitigating disruptions, and scalability of radiation oncology physics work during the COVID-19 pandemic. J Appl Clin Med Phys 2020; 21:187-195. [PMID: 32432389 PMCID: PMC7285927 DOI: 10.1002/acm2.12896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has led to disorder in work and livelihood of a majority of the modern world. In this work, we review its major impacts on procedures and workflow of clinical physics tasks, and suggest alternate pathways to avoid major disruption or discontinuity of physics tasks in the context of small, medium, and large radiation oncology clinics. We also evaluate scalability of medical physics under the stress of "social distancing". METHODS Three models of facilities characterized by the number of clinical physicists, daily patient throughput, and equipment were identified for this purpose. For identical objectives of continuity of clinical operations, with constraints such as social distancing and unavailability of staff due to system strain, however with the possibility of remote operations, the performance of these models was investigated. General clinical tasks requiring on-site personnel presence or otherwise were evaluated to determine the scalability of the three models at this point in the course of disease spread within their surroundings. RESULTS The clinical physics tasks within three models could be divided into two categories. The former, which requires individual presence, include safety-sensitive radiation delivery, high dose per fraction treatments, brachytherapy procedures, fulfilling state and nuclear regulatory commission's requirements, etc. The latter, which can be handled through remote means, include dose planning, physics plan review and supervision of quality assurance, general troubleshooting, etc. CONCLUSION: At the current level of disease in the United States, all three models have sustained major system stress in continuing reduced operation. However, the small clinic model may not perform if either the current level of infections is maintained for long or staff becomes unavailable due to health issues. With abundance, and diversity of innovative resources, medium and large clinic models can sustain further for physics-related radiotherapy services.
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Affiliation(s)
- Arash Darafsheh
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMO63110USA
| | - Hossein Lavvafi
- William E. Kahlert Regional Cancer CenterWestminsterMD21157USA
| | - Reza Taleei
- Department of Radiation OncologySidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPA19107USA
| | - Rao Khan
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMO63110USA
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22
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Mascarin M, Coassin E, Provenzi M, Franchin G, Mariotto A. How to Reorganize Children's Access to Radiation Therapy in the Era of COVID-19, to Protect Them and Elderly Patients. Adv Radiat Oncol 2020; 5:673-674. [PMID: 32292845 PMCID: PMC7151398 DOI: 10.1016/j.adro.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maurizio Mascarin
- AYA and Pediatric Radiotherapy Unit, CRO Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Elisa Coassin
- AYA and Pediatric Radiotherapy Unit, CRO Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Massimo Provenzi
- Pediatric Oncology Unit, Department of Pediatrics, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanni Franchin
- Radiotherapy Department, CRO Centro di Riferimento Oncologico IRCCS, Aviano, Italy
| | - Aldo Mariotto
- Medical Direction, CRO Centro di Riferimento Oncologico IRCCS, Aviano, Italy
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23
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Chen WC, Teckie S, Somerstein G, Adair N, Potters L. Guidelines to Reduce Hospitalization Rates for Patients Receiving Curative-Intent Radiation Therapy During the COVID-19 Pandemic: Report From a Multicenter New York Area Institution. Adv Radiat Oncol 2020; 5:621-627. [PMID: 32395672 PMCID: PMC7212958 DOI: 10.1016/j.adro.2020.04.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 01/08/2023] Open
Abstract
As the coronavirus disease 2019 pandemic spreads around the globe, access to radiation therapy remains critical for patients with cancer. The priority for all radiation oncology departments is to protect the staff and to maintain operations in providing access to those patients requiring radiation therapy services. Patients with tumors of the aerodigestive tract and pelvis, among others, often experience toxicity during treatment, and there is a baseline risk that adverse effects may require hospital-based management. Routine care during weekly visits is important to guide patients through treatment and to mitigate against the need for hospitalization. Nevertheless, hospitalizations occur and there is a risk of nosocomial severe acute respiratory syndrome coronavirus-2 spread. During the coronavirus disease 2019 pandemic, typical resources used to help manage patients, such as dental services, interventional radiology, rehabilitation, and others are limited or not at all available. Recognizing the need to provide access to treatment and the anticipated toxicity of such treatment, we have developed and implemented guidelines for clinical care management with the hope of avoiding added risk to our patients. If successful, these concepts may be integrated into our care directives in nonpandemic times.
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Affiliation(s)
- William C. Chen
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Gayle Somerstein
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
| | - Nilda Adair
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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24
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Price A, Henke LE, Maraghechi B, Kim T, Spraker MB, Hugo GD, Robinson CG, Knutson NC. Implementation of a Novel Remote Physician Stereotactic Body Radiation Therapy Coverage Process during the Coronavirus Pandemic. Adv Radiat Oncol 2020; 5:690-696. [PMID: 32346656 PMCID: PMC7186133 DOI: 10.1016/j.adro.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE During the coronavirus 2019 disease (COVID-19) pandemic, alternative methods of care are needed to reduce the relative risk of transmission in departments. Also needed is the ability to provide vital radiation oncological care if radiation oncologists (RO) are reallocated to other departments. We implemented a novel remote RO stereotactic body radiation therapy (SBRT) coverage practice, requiring it to be reliable, of high audio and visual quality, timely, and the same level of specialty care as our current in-person treatment coverage practice. METHODS AND MATERIALS All observed failure modes were recorded during implementation over the first 15 sequential fractions. The time from cone beam computed tomography to treatment was calculated before and after implementation to determine timeliness of remote coverage. Image quality metrics were calculated between the imaging console screen and the RO's shared screen. Comfort levels with audio and visual communication as well as overall comfort in comparison to in-person RO coverage was evaluated using Likert scale surveys after treatment. RESULTS Remote RO SBRT coverage was successfully implemented in 14 of 15 fractions with 3 observed process failures that were all corrected before treatment. Average times of pretreatment coverage before and after implementation were 8.74 and 8.51 minutes, respectively. The cross correlation between the imaging console screen and RO's shared screen was r = 0.96 and lag was 0.05 seconds. The average value for all survey questions was more than 4.5, approaching in-person RO coverage comfort levels. CONCLUSION Our novel method of remote RO SBRT coverage permits reduced personnel and patient interactions surrounding radiation therapy procedures. This may help to reduce transmission of COVID-19 in our department and provides a means for SBRT coverage if ROs are reallocated to other areas of the hospital for COVID-19 support.
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Affiliation(s)
- Alex Price
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
- Department of Engineering Management and Systems Engineering, Missouri University of Science and Technology, Rolla, Missouri
| | - Lauren E. Henke
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Borna Maraghechi
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Taeho Kim
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Matthew B. Spraker
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Geoffrey D. Hugo
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Clifford G. Robinson
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
| | - Nels C. Knutson
- Department of Radiation Oncology, Washington University in St Louis School of Medicine, St. Louis, Missouri
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26
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Spałek MJ, Rutkowski P. Coronavirus Disease (COVID-19) Outbreak: Hypofractionated Radiotherapy in Soft Tissue Sarcomas as a Valuable Option in the Environment of Limited Medical Resources and Demands for Increased Protection of Patients. Front Oncol 2020; 10:993. [PMID: 32582558 PMCID: PMC7292147 DOI: 10.3389/fonc.2020.00993] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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27
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Brachytherapy Issues and Priorities in the Context of the Coronavirus Disease 2019 (COVID-19) Outbreak. Adv Radiat Oncol 2020; 5:640-643. [PMID: 32775774 PMCID: PMC7266593 DOI: 10.1016/j.adro.2020.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Franco P, Kochbati L, Siano M, De Bari B. Suggestions for Radiation Oncologists during the COVID-19 Pandemic. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4892382. [PMID: 32509860 PMCID: PMC7254074 DOI: 10.1155/2020/4892382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
SARS-CoV-2 pandemic and COVID-19 diffusion have recently become an international public health emergency. Cancer patients, as a frail population, are particularly exposed to the risk related to infections. The clinical decision-making process and the organizational workflow of radiotherapy department should be revised in the light of the critical situation. We herein provide practical suggestions derived from the available literature and discussed during an online session held within the e-learning educational program of the European School of Oncology on March 31st 2020.
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Affiliation(s)
| | - Lofti Kochbati
- Department of Radiation Oncology, Ariana, Tunis El Manar University, Tunisia
| | - Marco Siano
- Interdisciplinary Cancer Service-SIC, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Berardino De Bari
- Department of Radiation Oncology, Réseal Hospitalier Neuchâtelois, La-Chaux-de Fonds, Switzerland
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29
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Yerramilli D, Xu AJ, Gillespie EF, Shepherd AF, Beal K, Gomez D, Yamada J, Tsai CJ, Yang TJ. Palliative Radiation Therapy for Oncologic Emergencies in the Setting of COVID-19: Approaches to Balancing Risks and Benefits. Adv Radiat Oncol 2020; 5:589-594. [PMID: 32363243 PMCID: PMC7194647 DOI: 10.1016/j.adro.2020.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Abstract
Palliation of metastatic disease compromises a significant portion of radiation treatments in the United States. These patients present a unique challenge in resource-limited settings, as expeditious treatment is often required to prevent serious morbidity. In order to reduce the risk of infection with severe acute respiratory syndrome coronavirus-2 and maximize the benefit to patients, we present evidence-based recommendations for radiation in patients with oncologic emergencies. Radiation oncologists with expertise in the treatment of metastatic disease at a high-volume comprehensive cancer center reviewed the available evidence and recommended best practices for the treatment of common oncologic emergencies, with attention to balancing the risk of infection with severe acute respiratory syndrome coronavirus-2 and the potential morbidity of delaying treatment. Many prospective trials and national guidelines support the use of abbreviated courses of radiotherapy for patients with oncologic emergencies. As such, in the setting of the current coronavirus disease 2019 pandemic, the use of hypofractionated radiation therapy for patients requiring palliation for oncologic emergencies achieves desirable functional outcomes without compromising care.
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Affiliation(s)
- Divya Yerramilli
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy J Xu
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Annemarie F Shepherd
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Beal
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Gomez
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josh Yamada
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Jillian Tsai
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T Jonathan Yang
- PROMISE (Precision Radiation for Oligometastatic and Metastatic Disease) Program, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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30
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Motlagh A, Yamrali M, Azghandi S, Azadeh P, Vaezi M, Ashrafi F, Zendehdel K, Mirzaei H, Basi A, Rakhsha A, Seifi S, Tabatabaeefar M, Elahi A, Pirjani P, Moadab Shoar L, Nadarkhani F, Khoshabi M, Bahar M, Esfahani F, Fudazi H, Samiei F, Farazmand B, Ahmari A, Vand Rajabpour M, Janbabaei G, Raisi A, Ostovar A, Malekzadeh R. COVID19 Prevention & Care; A Cancer Specific Guideline. ARCHIVES OF IRANIAN MEDICINE 2020; 23:255-264. [PMID: 32271599 DOI: 10.34172/aim.2020.07] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 01/01/2023]
Abstract
On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.
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Affiliation(s)
- Ali Motlagh
- National Cancer Control Secretariat, Ministry of Health and Medical Education, Tehran, Iran.,Department of Radiation Oncology, Shaheed Beheshti Medical University, Tehran, Iran
| | - Maisa Yamrali
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Azghandi
- Department of Hematology Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Payam Azadeh
- Department of Radiation Oncology, Shaheed Beheshti Medical University, Tehran, Iran
| | - Mohammad Vaezi
- Department of Hematology Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Ashrafi
- Department of Hematology Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mirzaei
- Department of Radiation Oncology, Shaheed Beheshti Medical University, Tehran, Iran
| | - Ali Basi
- Department of Hematology Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Rakhsha
- Department of Radiation Oncology, Shaheed Beheshti Medical University, Tehran, Iran
| | - Sharareh Seifi
- Department of Hematology Oncology, Shaheed Beheshti Medical University, Tehran, Iran
| | | | - Ahmad Elahi
- Department of Surgery, Alborz University of Medical Sciences, Karaj, Iran
| | - Pouneh Pirjani
- Ala Cancer Prevention and Control Center (MACSA), Tehran, Iran
| | - Leila Moadab Shoar
- Department of Radiation Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Faranak Nadarkhani
- Standard and Clinical Guidelines Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Mostafa Khoshabi
- Department of Geospatial Information System (GIS), Center of Excellence in GIS, K.N. Toosi Uni. of Technology, Tehran, Iran
| | - Massih Bahar
- Behnam Daheshpour Charity Organization, Tehran, Iran
| | - Fatemeh Esfahani
- Department of Hematology Oncology, Shaheed Beheshti Medical University, Tehran, Iran.,Iranian Society of Medical Oncology and Hematology, Tehran, Iran
| | | | - Farhad Samiei
- Iranian Cancer Association, Tehran, Iran.,Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Borna Farazmand
- Department of Radiation Oncology, Mashhad University of Medical Sciences, Ghouchan, Iran
| | - Azin Ahmari
- Department of Radiation Oncology, Arak University of Medical Sciences, Arak, Iran
| | - Mojtaba Vand Rajabpour
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabaei
- Department of Hematology Oncology, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Alireza Raisi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Afshin Ostovar
- National Cancer Control Secretariat, Ministry of Health and Medical Education, Tehran, Iran.,Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- National Cancer Control Secretariat, Ministry of Health and Medical Education, Tehran, Iran.,Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
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31
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Song K, Khan F. Cancer rehabilitation during the COVID-19 pandemic: An overview of special considerations. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2020. [DOI: 10.4103/jisprm.jisprm_10_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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32
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Chauhan R, Trivedi V, Rani R, Singh U, Singh V, Shubham S, Kumari S, Uniyal A. The impact of COVID-19 pandemic on the practice of radiotherapy: A retrospective single-institution study. CANCER RESEARCH, STATISTICS, AND TREATMENT 2020. [DOI: 10.4103/crst.crst_255_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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