Covid-19 outbreak in a major radiation oncology department; which lessons should be taken?

Forecasting Institutional LINAC Utilization in Response to Varying Workload

ObjectivesPandemics, natural disasters, and other unforeseen circumstances can cause short-term variation in radiotherapy utilization. In this study, we aim to develop a model to forecast linear accelerator (LINAC) utilization during periods of varying workloads. Methods: Using computed tomography (CT)-simulation data and the rate of new LINAC appointment bookings in the preceding week as input parameters, a multiple linear regression model to forecast LINAC utilization over a 15-working day horizon was developed and tested on institutional data. Results: Future LINAC utilization was estimated in our training dataset with a forecasting error of 3.3%, 5.9%, and 7.2% on days 5, 10, and 15, respectively. The model identified significant variations (≥5% absolute differences) in LINAC utilization with an accuracy of 69%, 62%, and 60% on days 5, 10, and 15, respectively. The results were similar in the validation dataset with forecasting errors of 3.4%, 5.3%, and 6.2% and accuracy of 67%, 60%, and 58% on days 5, 10, and 15, respectively. These results compared favorably to moving average and exponential smoothing forecasting techniques. Conclusions: The developed linear regression model was able to accurately forecast future LINAC utilization based on LINAC booking rate and CT simulation data, and has been incorporated into our institutional dashboard for broad distribution. Advances in knowledge: Our proposed linear regression model is a practical and intuitive approach to forecasting short-term LINAC utilization, which can be used for resource planning and allocation during periods with varying LINAC workloads.

Oncology nursing in the Global South during COVID-19

In mid-2020, a call was made to oncology nurses in the Global South to share their experiences managing patient care during the coronavirus disease 2019 (COVID-19) pandemic. Eighteen submissions were received from 16 countries across Latin America, Africa, Europe and Asia. Three were research-based and 15 were personal narratives on the psychosocial impact of COVID-19 on the nurses, colleagues, patients and families. Three narratives were from oncology nurses working with cancer-related non-governmental organisations locally or, in one case, internationally. A simultaneous literature search for publications (including grey literature) was performed to identify themes of COVID-19’s impact in these 16 countries and specifically on oncology nurses and patients/families. Four themes were identified: a) interruptions to care; b) support/resource shortages; c) psychosocial impact on nurses and patients and d) staffing and nursing role impacts. The three research-based studies describe oncology nursing in-depth efforts to explore the impact of COVID-19. Findings in the 15 narratives are briefly presented according to the four themes identified in the literature. Due to the severe shortage of physician adult and paediatric oncology specialists, oncology nurses in the Global South often shoulder much of the care for patients with cancer and even more so during COVID-19 with attendant oncology nursing shortages due to reassignment to COVID-19 units. It is important to hear from these critical members of the oncology nursing workforce who often lack the time, resources or training to publish in peer-reviewed journals in English, particularly in the middle of a pandemic. Giving voice to these nurses documents the reality of their work and ability to continue to provide care despite the chaos and rapidly changing guidelines and government action. Lessons learned by these nurses to improve mental health and psychosocial support of the nurses as well as their patients/families will be essential for the next global pandemic.

Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: the NORMALITY model

Introduction

The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy.

This paper has two aims: (1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named “La Rete del Sollievo” (“The Net of Relief”)]. The proposed model, denoted “No cOmpRoMise on quality of life by pALliative radiotherapy” (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19).

Material and Methods

First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups: palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed.

Results

After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed: palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., “Normality model of PRT indications”) for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits.

Conclusion

We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.

Radiation Therapy During the COVID-19 Pandemic: Experience from Beijing, China

BACKGROUND

Coronavirus disease 2019 (COVID-19) is now a global pandemic. It is unclear to radiotherapy practitioners how to carry out radiotherapy during the epidemic.

PATIENTS AND METHODS

After the outbreak of COVID-19, our Institute established measures for the prevention and control of COVID-19, and continues to treat patients according to these measures. The Radiotherapy Department has been divided into a clean zone and a semi-contaminated zone, and corresponding personal protective equipment is used in these zones. The temperature of patients and their escorts, and history of fever are assessed daily. Special procedures are performed during radiotherapy setup and intracavitary brachytherapy.

RESULTS

Over a period of 2 months, 655 patients were treated in the Department. Sixteen patients with fever were identified and no patient undergoing radiotherapy or medical staff have been infected with COVID-19.

CONCLUSION

Our protective measures were found to be effective and can be used as a reference in places where COVID-19 situations are not markedly serious.

Evolution of clinical radiotherapy physics practice under COVID-19 constraints

As the COVID-19 spread continues to challenge the societal and professional norms, radiotherapy around the globe is pushed into an unprecedented transformation. We will discuss how clinical physics has transformed to ascertain safety and quality standards across four facilities around the world through diversity of action, innovation, and scientific flexibility.