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COVID and Radiotherapy

March 14, 2020

This month for Journal Club we have made a change to our original plans and decided to have an urgent forum on the very pressing and global problem of COVID-19.

Many countries are struggling already under the burden of this disease and many more are likely to be facing extreme pressures in the coming weeks. This will impact all of us. I am writing this blog post a few weeks after coming out of isolation and a few hours after a long meeting in my department and immediately before I ring a long list of patients. I have the time because the soccer game and the concert I was going to this weekend have both been cancelled.

As healthcare workers we have a responsibility to support our patients and plan as best we can. In the UK the the Government classified its’ response in 4 stages; contain, delay, research and mitigate. We are beyond stage 1 but we can still have influence on the latter 3.

For all healthcare workers there are some generic questions: how do we support infected patients and how do we limit spread? All departments will have their own challenges around maintaining services with reduced workforce through sickness or self-isolation. In radiation oncology we have some particular challenges around our mixed population (unwell palliative patients alongside relatively fit patients receiving adjuvant treatments), the length of our treatment courses and the fact that our treatment is delivered by static equipment used by different patients in constant sequence raising the possibility of cross contamination.

How can we best respond? Some departments are struggling now, some are likely to be struggling in weeks from now.

This weekend we would like to consider these four main questions:

T1: how do we deliver treatments with reduced workforce

Are there ways of working remotely that can still utilise an isolated workforce? Do we move to more simple plans and/or hypofractionate. What barriers exist to making these changes urgently?

T2: what risks to our patients can we mitigate

Are we exposing cancer patients to risk (especially with chemotherapy) but are there other risks we should consider e.g. pneumonitis. Can we reduce  cross infections?

T3: should we change/stop/delay certain treatments?

T4: how do we treat a confirmed #COVID case with #radonc ?

What are the infection control policies and procedures that will work most effectively from a a regional unit with a single LinAC to a 16 bunker department?

Wherever possible we would like to discuss evidence so posted link will be helpful.

We will post regular polls through the weekend to gauge strength of support for proposed approaches

At the end of this weekend we would like to be able to assemble a peer-sourced compilation of advice, guidance and evidence that could be used by Departments from Monday onwards to start making changes.

Thank you everyone.

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