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Islam JY, Hathaway CA, Hume E, Turner K, Hallanger-Johnson J, Tworoger SS, Camacho-Rivera M. Racial and Ethnic Inequities in Cancer Care Continuity During the COVID-19 Pandemic Among Those With SARS-CoV-2. JAMA Netw Open 2024; 7:e2412050. [PMID: 38767916 PMCID: PMC11107297 DOI: 10.1001/jamanetworkopen.2024.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 05/22/2024] Open
Abstract
Importance Racially and ethnically minoritized US adults were disproportionately impacted by the COVID-19 pandemic and experience poorer cancer outcomes, including inequities in cancer treatment delivery. Objective To evaluate racial and ethnic disparities in cancer treatment delays and discontinuations (TDDs) among patients with cancer and SARS-CoV-2 during different waves of the COVID-19 pandemic in the United States. Design, Setting, and Participants This cross-sectional study used data from the American Society of Clinical Oncology Survey on COVID-19 in Oncology Registry (data collected from April 2020 to September 2022), including patients with cancer also diagnosed with SARS-CoV-2 during their care at 69 US practices. Racial and ethnic differences were examined during 5 different waves of the COVID-19 pandemic in the United States based on case surge (before July 2020, July to November 2020, December 2020 to March 2021, April 2021 to February 2022, and March to September 2022). Exposures Race and ethnicity. Main Outcomes and Measures TDD was defined as any cancer treatment postponed more than 2 weeks or cancelled with no plans to reschedule. To evaluate TDD associations with race and ethnicity, adjusted prevalence ratios (aPRs) were estimated using multivariable Poisson regression, accounting for nonindependence of patients within clinics, adjusting for age, sex, body mass index, comorbidities, cancer type, cancer extent, and SARS-CoV-2 severity (severe defined as death, hospitalization, intensive care unit admission, or mechanical ventilation). Results A total of 4054 patients with cancer and SARS-CoV-2 were included (143 [3.5%] American Indian or Alaska Native, 176 [4.3%] Asian, 517 [12.8%] Black or African American, 469 [11.6%] Hispanic or Latinx, and 2747 [67.8%] White; 2403 [59.3%] female; 1419 [35.1%] aged 50-64 years; 1928 [47.7%] aged ≥65 years). The analysis focused on patients scheduled (at SARS-CoV-2 diagnosis) to receive drug-based therapy (3682 [90.8%]), radiation therapy (382 [9.4%]), surgery (218 [5.4%]), or transplant (30 [0.7%]), of whom 1853 (45.7%) experienced TDD. Throughout the pandemic, differences in racial and ethnic inequities based on case surge with overall TDD decreased over time. In multivariable analyses, non-Hispanic Black (third wave: aPR, 1.56; 95% CI, 1.31-1.85) and Hispanic or Latinx (third wave: aPR, 1.35; 95% CI, 1.13-1.62) patients with cancer were more likely to experience TDD compared with non-Hispanic White patients during the first year of the pandemic. By 2022, non-Hispanic Asian patients (aPR, 1.51; 95% CI, 1.08-2.12) were more likely to experience TDD compared with non-Hispanic White patients, and non-Hispanic American Indian or Alaska Native patients were less likely (aPR, 0.37; 95% CI, 0.16-0.89). Conclusions and Relevance In this cross-sectional study of patients with cancer and SARS-CoV-2, racial and ethnic inequities existed in TDD throughout the pandemic; however, the disproportionate burden among racially and ethnically minoritized patients with cancer varied across SARS-CoV-2 waves. These inequities may lead to downstream adverse impacts on cancer mortality among minoritized adults in the United States.
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Affiliation(s)
- Jessica Y. Islam
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Cassandra A. Hathaway
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Emma Hume
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Division of Oncological Sciences, School of Medicine, Oregon Health & Science University, Portland
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, New York, New York
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Kosydar S, Woodfin MW, Halasz LM, Apisarnthanarax S, Rengan R, Lo SS. The Impact of COVID-19 on US Radiation Oncology Residents. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1525-1531. [PMID: 33694133 PMCID: PMC7946574 DOI: 10.1007/s13187-021-01993-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
The purpose of our study is to assess the impact of COVID-19 on the clinical responsibilities, training, and wellness of US radiation oncology residents. An anonymous cross-sectional survey was sent to all 91 radiation oncology residency programs in the USA. The survey included questions related to demographics, changes in clinical duties and training, job prospects, and wellness indicators. Univariate and multivariate logistic regression analyses were used to evaluate factors associated with residents endorsing high satisfaction with their departments' response to COVID-19. A total of 96 residents completed the survey from 67 US radiation oncology programs. In the multivariate logistic regression model, remote contouring (OR: 3.91 (95% CI: 1.11, 13.80), p = 0.03) and belief that one will be adequately trained to independently practice after completing residency (OR: 4.68 (1.12, 19.47), p = 0.03) were significantly associated with high resident satisfaction with their department's response to COVID-19. Most residents indicated that hypofractionation was encouraged to a greater extent (n = 79, 82.3%), patients were triaged by disease risk (n = 67, 69.8%), and most agreed/strongly agreed that they have been provided with adequate personal protective equipment (PPE) (n = 85, 88.5%). The COVID-19 pandemic has affected the training and wellness of radiation oncology residents. Our analysis suggests that radiation oncology programs might increase resident satisfaction with their department's response to COVID-19 by enabling remote contouring and working with residents to identity and remedy possible concerns regarding their ability to independently practice post residency.
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Affiliation(s)
- Samuel Kosydar
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | - Lia M Halasz
- School of Medicine, University of Washington, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Smith Apisarnthanarax
- School of Medicine, University of Washington, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Ramesh Rengan
- School of Medicine, University of Washington, Seattle, WA, USA
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Simon S Lo
- School of Medicine, University of Washington, Seattle, WA, USA.
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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Niaee MS, Zolghadr L, Hosseinkhani Z, Namdar P, Allami A, Amini F, Varnaseri M, Pourdast A, Gheibi N. Ivermectin-Induced Clinical Improvement and Alleviation of Significant Symptoms of COVID-19 Outpatients: A Cross-Sectional Study. IRANIAN JOURNAL OF SCIENCE AND TECHNOLOGY, TRANSACTIONS A: SCIENCE 2022; 46:1369-1375. [PMID: 36187299 PMCID: PMC9510226 DOI: 10.1007/s40995-022-01349-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/20/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Leila Zolghadr
- Department of Chemistry, Imam Khomeini International University, Qazvin, Iran
| | - Zahra Hosseinkhani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Peyman Namdar
- Department of Surgery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Abbas Allami
- Department of Infectious Diseases, Clinical Research Development Unit, Bou Ali Sina Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Amini
- Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehran Varnaseri
- Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Allieh Pourdast
- Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran, Iran
| | - Nematollah Gheibi
- Cellular and Molecular Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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A Novel Benchmark Dataset for COVID-19 Detection during Third Wave in Pakistan. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:6354579. [PMID: 35990145 PMCID: PMC9391128 DOI: 10.1155/2022/6354579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Coronavirus (COVID-19) is a highly severe infection caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2). The polymerase chain reaction (PCR) test is essential to confirm the COVID-19 infection, but it has certain limitations, including paucity of reagents, is computationally time-consuming, and requires expert clinicians. Clinicians suggest that the PCR test is not a reliable automated COVID-19 patient detection system. This study proposed a machine learning-based approach to evaluate the PCR role in COVID-19 detection. We collect real data containing 603 COVID-19 samples from the Pakistan Institute of Medical Sciences (PIMS) Hospital in Islamabad, Pakistan, during the third COVID-19 wave. The experiments are separated into two sets. The first set comprises 24 features, including PCR test results, whereas the second comprises 24 features without PCR test. The findings demonstrate that the decision tree achieves the best detection rate for positive and negative COVID-19 patients in both scenarios. The findings reveal that PCR does not contribute to detecting COVID-19 patients. The findings also aid in the early detection of COVID-19, mainly when PCR test results are insufficient for diagnosing COVID-19 and help developing countries with a paucity of PCR tests and specialist facilities.
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Czmielewski C, Gallina V, Tripoli D, Lenards N, Hunzeker A, Zeiler S. Analyzing changes in radiotherapy treatment planning error reporting during the COVID-19 pandemic. Med Dosim 2022; 47:248-251. [PMID: 35584973 PMCID: PMC8995205 DOI: 10.1016/j.meddos.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022]
Abstract
The 2019 coronavirus (COVID-19) pandemic has affected medical physics and radiation oncology departments and the delivery of radiation therapy. Among the changes implemented in response to the onset of the pandemic was a shift to remote treatment planning by health care institutions. The purpose of this study was to determine whether the overall frequency of errors changed after the implementation of remote radiation therapy treatment planning during the COVID-19 pandemic. Reported incidents were obtained from an incident reporting database operated by a multisite cancer care facility in the Northeast. Researchers compared the frequency of reported events in a period prior to the start of the pandemic (March 2019 to February 2020) with a period after the onset of the pandemic (March 2020 to February 2021). No significant increase in reported incidents was detected suggesting the efficiency and safety of remote radiotherapy treatment planning.
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Affiliation(s)
| | - Victoria Gallina
- Medical Dosimetry Program, University of Wisconsin-La Crosse, WI 54601, USA
| | - Dylan Tripoli
- Medical Dosimetry Program, University of Wisconsin-La Crosse, WI 54601, USA
| | - Nishele Lenards
- Medical Dosimetry Program, University of Wisconsin-La Crosse, WI 54601, USA
| | - Ashley Hunzeker
- Medical Dosimetry Program, University of Wisconsin-La Crosse, WI 54601, USA
| | - Sabrina Zeiler
- Medical Dosimetry Program, University of Wisconsin-La Crosse, WI 54601, USA
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6
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Kapur A, Rudin B, Potters L. Post Traumatic Growth in Radiation Medicine following the COVID-19 Outbreak. Adv Radiat Oncol 2022; 7:100975. [PMID: 35464494 PMCID: PMC9014650 DOI: 10.1016/j.adro.2022.100975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/14/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose It has been reported that adversarial growth during traumatic events potentially enhances coping with sequelae. The purpose of this work was to assess posttraumatic growth (PTG) among radiation medicine staff members at the individual level as well as changes in perceptions of departmental culture after the COVID-19 pandemic. Methods and Materials An anonymous PTG inventory (PTGI) survey comprising 21 indicators was disseminated to all 213 members of our multicenter radiation department to measure perceptions of change in personal, interpersonal-relationship, and philosophy of life factors using principal-factor analysis. Additionally, 8 department safety-culture indicators from the National Hospital Patient Safety Culture Survey developed by the Agency for Healthcare Research and Quality were included to assess changes in department safety-culture perceptions verses a prepandemic survey. The survey was repeated 15 months later to assess longitudinal trends. Results With a 56.3% survey-response rate, PTGI factor analysis yielded Cronbach's alpha values exceeding 0.90 for the 3 aforementioned PTG factors. The average growth per indicator was 2.3 (out of 5.0), which fell between small and moderate. The values were 2.4 (personal), 2.1 (interpersonal), and 1.6 (philosophy) for the 3 factors. The total PTGI score (47.7 ± 28.3 out of 105 points) was lower for masked, patient-facing, frontline workers members (41.8 ± 28.4) compared with others (53.1 ± 27.3, P value .001). For the Agency for Healthcare Research and Quality survey there was an improvement of 15% in perceptions of department safety culture, and 7 of the 8 indicators showed improvements compared with baseline. The follow-up survey demonstrated overall sustained findings, albeit with a trend toward declining PTG scores for nonfrontline workers, notably in interpersonal relationships (47.4 ± 27.0, P value .05). Conclusions A fair-to-moderate degree of PTG was observed in personal and interpersonal relationship factors whereas least growth was noted in spiritual and religious beliefs. Perceptions of department patient-safety culture improved substantially. Sustained improvements were thus perceived at the individual and department levels.
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Affiliation(s)
- Ajay Kapur
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
| | - Brett Rudin
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York
- Zucker School of Medicine, Hempstead, New York
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Cancer Patients’ Challenges During COVID-19 Pandemic: An Approach to Decision-Making in Management and Policy-Making. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid.104590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Context: Cancer patients are more susceptible to novel coronavirus infection due to their immune system deficiency and anticancer treatments. During the COVID-19 outbreak, cancer patients have faced many challenges. The present study aimed to review the literature on cancer patients’ challenges during the COVID-19 pandemic to offer an approach to decision-making in management and policy-making. Evidence Acquisition: In this review study, national and international databases were searched. Inclusion Criteria were the risk of COVID-19 in cancer patients, medical services, surgery, and cancer screening during the COVID-19 pandemic, cancer patients’ challenges during the COVID-19 pandemic, and management and policy-making in this pandemic. Results: Cancer patients’ challenges during the COVID 19 pandemic were classified as follows: (1) risk of COVID-19 for cancer patients; (2) access to medical services and screening during the COVID-19 pandemic; and (3) psychological disorders during the COVID-19 pandemic. Studies have revealed that individuals with cancer experience a higher risk of the COVID-19 infection and mortality compared to healthy individuals. Most oncology clinics postpone unnecessary appointments; however, patients with invasive cancer are treated with no delay. Proper management, disease control, and attention to mental health care can prevent psychological disorders. Conclusions: Managing cancer patients’ challenges during the SARS-CoV-2 is of paramount importance. Cancer clinics need to develop new care and follow-up protocols. Moreover, policy-makers should provide appropriate policies to address the challenges of this disease in the future.
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Goodman CD, Correa RJ, Arifin AJ, Dinniwell RE, Laba JM, Nguyen TK. A Framework for Assuring the Safety, Training, Evaluation, and Wellness of Radiation Oncology Residents During the COVID-19 Pandemic (ASTEROiD-COVID19). Adv Radiat Oncol 2021; 6:100754. [PMID: 34307965 PMCID: PMC8285368 DOI: 10.1016/j.adro.2021.100754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/26/2021] [Accepted: 07/07/2021] [Indexed: 01/12/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic continues to disrupt nearly all facets of daily life, residency programs must ensure the safety and wellness of their residents while maintaining a commitment to their training and advancement. In addition to standard clinical training, radiation oncology residency programs integrate highly specialized elements specific to the delivery of radiation therapy. Few publications have addressed the significant effects of the pandemic on medical training and even fewer have addressed concerns specific to radiation oncology. We report our experience developing a resident-led adaptation of our training program in response to the COVID-19 pandemic with the aim of assisting other programs to meet this challenge.
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Affiliation(s)
- Christopher D. Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Rohann J.M. Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew J. Arifin
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Robert E. Dinniwell
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna M. Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Timothy K. Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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Miller RC, Tsai J. The Top 10 Downloads of 2020 in ASTRO's Advances in Radiation Oncology. Adv Radiat Oncol 2021; 6:100678. [PMID: 34195494 PMCID: PMC8233462 DOI: 10.1016/j.adro.2021.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Robert C Miller
- Division of Radiation Oncology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Affiliation(s)
- Ehab Hanna
- Department of Head and Neck Surgery, Center Medical Directory, Head and Neck Center, University of Texas, MD Anderson Cancer Center, Houston, Texas
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11
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Samper Ots PM, Zapatero Ortuño J, Pedraza Fernández S, Mayrata Canellas E, González San Segundo C, Campo Vargas M, Caballero B, Ramos Albiac M, Vázquez Masedo G, Álvarez B, Rodríguez Villalba S, Muñoz Miguelañez T, Diezhandino Garcia P, Sancho G, Guzmán Gómez L, Tripero J, Rico Oses MR, Ibañez Villoslada C, Soler Rodríguez AMS, Chust ML, Fondevilla Soler A, Lozano Martin EM, Morillo Macias V, Fuentes Sánchez C, Torrado Moya L, Fernández López J, Solé JM, Guijarro Verdú M, Mira Flores M, Wals A, Expósito Hernández J. Impact of covid-19 on patients in radiotherapy oncology departaments in Spain. Radiother Oncol 2021; 161:148-151. [PMID: 34118358 PMCID: PMC8189749 DOI: 10.1016/j.radonc.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
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Shanahan MC, Akudjedu TN. Australian radiographers' and radiation therapists' experiences during the COVID-19 pandemic. J Med Radiat Sci 2021; 68:111-120. [PMID: 33590670 PMCID: PMC8013350 DOI: 10.1002/jmrs.462] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Radiographers and radiation therapists are key patient-facing health practitioners supporting the delivery of optimal patient care during the COVID-19 pandemic. The aim of this research was to investigate the impact of COVID-19 on clinical service delivery and well-being of these healthcare professionals in Australia. METHODS A cross-sectional online survey of Australian radiographers and radiation therapists was conducted in June-July 2020. The survey collected data on demographic characteristics, and the impact of COVID-19 on professional practice, infection control and workplace-related stress. RESULTS A total of 218 responses were received. Changes in work hours (P < 0.001) and workload (P = 0.022) were experienced due to COVID-19. Diagnostic radiographers reported increased procedural pressure on mobile radiography, computed tomography and general radiography. For radiation therapists, most pressure included areas of simulation and linear accelerator. PPE was in short supply at the start of the pandemic, and at the time of the study, shortages were identified for all PPE items. There was no difference in PPE supply reported by diagnostic radiographers and radiation therapists except for hand sanitiser (P = 0.003). Respondents experienced increased personal stress (61.4%) and anxiety (58.2%) at work due to COVID-19. In addition, their work caused increased stress to their family, partners or friends (57.4%). CONCLUSIONS COVID-19 has resulted in changes to clinical working patterns and service delivery. PPE shortages, as well as increased workplace-related stress, were identified. Workplaces should seek to mitigate the pandemic impact through the provision of adequate PPE for safe practice as well as implement strategies to support and enhance staff well-being.
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Affiliation(s)
- Madeleine C Shanahan
- Discipline of Medical Radiation ScienceFaculty of HealthUniversity of CanberraBruceACTAustralia
| | - Theophilus N Akudjedu
- Institute of Medical Imaging & VisualisationFaculty of Health & Social SciencesBournemouth UniversityBournemouthUK
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COVID-19 in Patients with Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:315-331. [PMID: 33973186 DOI: 10.1007/978-3-030-63761-3_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With more than 5 million cases and 333,212 deaths, COVID-19 (or SARS-CoV-2) continues to spread. General symptoms of this disease are similar to that of many other viral respiratory diseases, including fever, cough, dyspnea, and fatigue, with a chance of progression to more severe complications. However, the virus does not affect all people equally, and cases with comorbidities such as malignancies, cardiovascular diseases, respiratory diseases, and kidney diseases are at higher risk of developing severe events, including requiring intensive ventilation, intensive care unit (ICU) admission, and death. Patients with cancer are more likely to be infected with COVID-19, which is possibly due to their immunological dysfunction or frequent clinic visits. Also, there is a higher chance that these patients experience severe events because of the medication they receive. In this chapter, we will review the main clinical manifestations of COVID-19 in patients with cancer. Recommendations and challenges for managing resources, organizing cancer centers, treatment of COVID-19-infected cancer patients, and performing cancer research during this pandemic will also be discussed.
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Pendyala P, Goglia AG, Mattes MD, Grann A, Huang D, Wagman RT, Yehia ZA, Yoon J, Ennis RD. Impact of the Coronavirus Disease of 2019 Pandemic on Radiation Oncology Clinical Decision Making in a High-Prevalence Environment. Adv Radiat Oncol 2021; 6:100680. [PMID: 33686375 PMCID: PMC7929864 DOI: 10.1016/j.adro.2021.100680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study aimed to define how the coronavirus disease of 2019 (COVID-19) pandemic affected the role, timing, and delivery of radiation therapy (RT) in a high-prevalence region at the height of the initial U.S. outbreak. METHODS AND MATERIALS We performed a retrospective review of all patients seen at 3 radiation oncology departments within the Rutgers Robert Wood Johnson Barnabas Health system in New Jersey during the initial COVID-19 surge. The primary endpoints were to define and quantify COVID-related, radiation-specific care changes, and identify predictive factors of experiencing COVID-related care changes. RESULTS A total of 545 patients with cancer were seen during the study period, 99 of whom (18.1%) experienced ≥1 COVID-related care change. RT delays were the most common, accounting for 51.5% of all care changes. Physician-directed delays accounted for 41.2% of RT delays, and patient fears, COVID testing, and access barriers were responsible for 27.5%, 17.6%, and 13.7%, respectively. Patient age (P = .040), intent of treatment (P = .047), and cancer type (P < .001) were significantly associated with experiencing a COVID-related care change, as we found that older, curative intent and patients with rectal cancer were more likely to experience care changes. On multivariate analysis, patient age remained significant when controlling for treatment intent and cancer type. CONCLUSIONS Our study provides a perspective on how care was adapted to protect patients with cancer during a pandemic while maximizing disease control. The positive correlation between age and likelihood of care changes may reflect extra precaution taken with older patients given their vulnerability to severe COVID illness. The lower observed likelihood of COVID-related care changes among patients undergoing palliative RT may reflect either the more urgent needs addressed by palliative RT or simply be logistical, because palliative radiation is often delivered in short courses with less exposure risk. Assessing adaptations others have implemented and monitoring how they affect patient outcomes will be crucial.
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Affiliation(s)
- Praveen Pendyala
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | | | - Alison Grann
- Robert Wood Johnson Barnabas Health, Livingston, New Jersey
| | - David Huang
- Robert Wood Johnson Barnabas Health, Livingston, New Jersey
| | | | | | - Jennifer Yoon
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ronald D. Ennis
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Impact of COVID-19 pandemic on the oncologic care continuum: urgent need to restore patients care to pre-COVID-19 era. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [PMCID: PMC8060543 DOI: 10.1017/s1460396921000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Background:
Globally, cancer is the second leading cause of death, and it is estimated that over 18·1 million new cases are diagnosed annually. The COVID-19 pandemic has significantly impacted almost every aspect of the provision and management of cancer care worldwide. The time-critical nature of COVID-19 diagnosis and the large number of patients requiring hospitalisation necessitated the rerouting of already limited resources available for cancer services and programmes to the care of COVID-19 patients. Furthermore, the stringent social distancing, restricted in-hospital visits and lockdown measures instituted by various governments resulted in the disruption of the oncologic continuum including screening, diagnostic and prevention programmes, treatments and follow-up services as well as research and clinical trial programmes.
Materials and Methods:
We searched several databases from October 2020 to January 2021 for relevant studies published in English between 2020 and 2021 and reporting on the impact of COVID-19 on the cancer care continuum. This narrative review paper describes the impact of the COVID-19 pandemic on the cancer patient care continuum from screening and prevention to treatments and ongoing management of patients.
Conclusions:
The COVID-19 pandemic has profoundly impacted cancer care and the management of cancer services and patients. Nevertheless, the oncology healthcare communities worldwide have done phenomenal work with joint and collaborative efforts, utilising best available evidence-based guidelines to continue to give safe and effective treatments for cancer patients while maintaining the safety of patients, healthcare professionals and the general population. Nevertheless, several healthcare centres are now faced with significant challenges with the management of the backlog of screening, diagnosis and treatment cases. It is imperative that governments, leaders of healthcare centres and healthcare professionals take all necessary actions and policies focused on minimising further system-level delays to cancer screening, diagnosis, treatment initiation and clearing of all backlogs cases from the COVID-19 pandemic in order to mitigate the negative impact on cancer outcomes.
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Romero J, Benlloch R, Obeso J, Engel O, Gil B, Córdoba S, Zapata I, López M, Portero F. Impact of COVID-19 pandemic on patients and health professionals of a radiation oncology department at a Spanish tertiary hospital. ACTA ACUST UNITED AC 2021; 26:237-241. [PMID: 34211774 DOI: 10.5603/rpor.a2021.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/04/2021] [Indexed: 11/25/2022]
Abstract
Background The sanitary emergency created by the COVID-19 pandemic forced us to take exceptional measures that affect decision-making and administration of treatments with radiotherapy. The aim of the study was to analyze the impact of the COVID-19 pandemic on patients and professionals in a radiation oncology department. Materials and methods We implement a plan with the objectives of maintaining radiotherapy treatment in those patients who need it and, at the same time, reducing the risk of spreading the virus to staff and patients. This plan included measures aimed at limiting the patient's stay in hospital, selecting those patients in whom radiotherapy cannot be delayed and protecting against infection through the use of physical protective measures. Results Between March 16 and May 31, 2020, 360 patients received radiotherapy in our department. In 14 patients (4.7%) the start of treatment was delayed by an average of 28 days. Four patients had a positive COVID-19 polymerase chain reaction (PCR ) (6.6% and 1.1% of tested and all patients, respectively). Among the professionals, two PCR s were positive (16.6% and 4% of tested and all individuals, respectively). In the serology analysis 4 out of 50 department members were IgG positive (8%). Conclusions Despite the fact that our department is located in a region with a high incidence of COVID-19 infection, the impact of the pandemic on our patients and staff has been moderate. The implementation of measures against infection and an adequate selection of patients for treatment allows radiation oncology departments to maintain clinical activity.
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Affiliation(s)
- Jesús Romero
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Raquel Benlloch
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jorge Obeso
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Olga Engel
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Beatriz Gil
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Sofía Córdoba
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Irma Zapata
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Marta López
- Servicio de Oncología Radioterápica; Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Francisca Portero
- Servicio de Microbiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Satisfaction among Cancer Patients Undergoing Radiotherapy during the COVID-19 Pandemic: An Institutional Experience. ACTA ACUST UNITED AC 2021; 28:1507-1517. [PMID: 33920247 PMCID: PMC8167586 DOI: 10.3390/curroncol28020142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has shifted oncology practices to prioritize patient safety while maintaining necessary treatment delivery. We obtained patient feedback on pandemic-based practices in our radiotherapy department to improve quality of patient care and amend policies as needed. We developed a piloted questionnaire which quantitatively and qualitatively assessed patients’ pandemic-related concerns and satisfaction with specific elements of their care. Adult patients who were treated at our Centre between 23 March and 31 May 2020, had initial consultation via telemedicine, and received at least five outpatient fractions of radiotherapy were invited to complete the survey by telephone or online. Relative frequencies of categorical and ordinal responses were then calculated. Fifty-three (48%) out of 110 eligible patients responded: 32 patients by phone and 21 patients online. Eighteen participants (34%) admitted to feeling anxious about hospital appointments, and only five (9%) reported treatment delays. Forty-eight patients (91%) reported satisfaction with their initial telemedicine appointment. The majority of patients indicated that healthcare workers took appropriate precautions, making them feel safe. Overall, all 53 patients (100%) reported being satisfied with their treatment experience during the pandemic. Patient feedback is needed to provide the highest quality of patient care as we adapt to the current reality.
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Tabrizi S, Trippa L, Cagney D, Aizer AA, Tanguturi S, Ventz S, Fell G, Bellon JR, Mamon H, Nguyen PL, D’Amico AV, Haas-Kogan D, Alexander BM, Rahman R. Assessment of Simulated SARS-CoV-2 Infection and Mortality Risk Associated With Radiation Therapy Among Patients in 8 Randomized Clinical Trials. JAMA Netw Open 2021; 4:e213304. [PMID: 33779742 PMCID: PMC8008289 DOI: 10.1001/jamanetworkopen.2021.3304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE During the COVID-19 pandemic, cancer therapy may put patients at risk of SARS-CoV-2 infection and mortality. The impacts of proposed alternatives on reducing infection risk are unknown. OBJECTIVE To investigate how the COVID-19 pandemic is associated with the risks and benefits of standard radiation therapy (RT). DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used estimated individual patient-level data extracted from published Kaplan-Meier survival figures from 8 randomized clinical trials across oncology from 1993 to 2014 that evaluated the inclusion of RT or compared different RT fractionation regimens. Included trials were Dutch TME and TROG 01.04 examining rectal cancer; CALGB 9343, OCOG hypofractionation trial, FAST-Forward, and NSABP B-39 examining early stage breast cancer, and CHHiP and HYPO-RT-PC examining prostate cancer. Risk of SARS-CoV-2 infection and mortality associated with receipt of RT in the treatment arms were simulated and trials were reanalyzed. Data were analyzed between April 1, 2020, and June 30, 2020. EXPOSURES COVID-19 risk associated with treatment was simulated across different pandemic scenarios, varying infection risk per fractions (IRFs) and case fatality rates (CFRs). MAIN OUTCOMES AND MEASURES Overall survival was evaluated using Cox proportional hazards modeling under different pandemic scenarios. RESULTS Estimated IPLD from a total of 14 170 patients were included in the simulations. In scenarios with low COVID-19-associated risks (IRF, 0.5%; CFR, 5%), fractionation was not significantly associated with outcomes. In locally advanced rectal cancer, short-course RT was associated with better outcomes than long-course chemoradiation (TROG 01.04) and was associated with similar outcomes as RT omission (Dutch TME) in most settings (eg, TROG 01.04 median HR, 0.66 [95% CI, 0.46-0.96]; Dutch TME median HR, 0.91 [95% CI, 0.80-1.03] in a scenario with IRF 5% and CFR 20%). Moderate hypofractionation in early stage breast cancer (OCOG hypofractionation trial) and prostate cancer (CHHiP) was not associated with survival benefits in the setting of COVID-19 (eg, OCOG hypofractionation trial median HR, 0.89 [95% CI, 0.74-1.06]; CHHiP median HR, 0.87 [95% CI, 0.75-1.01] under high-risk scenario with IRF 10% and CFR 30%). More aggressive hypofractionation (FAST-Forward, HYPO-RT-PC) and accelerated partial breast irradiation (NSABP B-39) were associated with improved survival in higher risk scenarios (eg, FAST-Forward median HR, 0.58 [95% CI, 0.49-0.68]; HYPO-RT-PC median HR, 0.60 [95% CI, 0.48-0.75] under scenario with IRF 10% and CFR 30%). CONCLUSIONS AND RELEVANCE In this comparative effectiveness study of data from 8 clinical trials of patients receiving radiation therapy to simulate COVID-19 risk and mortality rates, treatment modification was not associated with altered risk from COVID-19 in lower-risk scenarios and was only associated with decreased mortality in very high COVID-19-risk scenarios. This model, which can be adapted to dynamic changes in COVID-19 risk, provides a flexible, quantitative approach to assess the potential impact of treatment modifications and supports the continued delivery of standard evidence-based care with appropriate precautions against COVID-19.
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Affiliation(s)
- Shervin Tabrizi
- Harvard Radiation Oncology Program, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Harvard School of Public Health, Boston, Massachusetts
| | - Daniel Cagney
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ayal A. Aizer
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Shyam Tanguturi
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Steffen Ventz
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Harvard School of Public Health, Boston, Massachusetts
| | - Geoffrey Fell
- Dana-Farber Cancer Institute, Department of Biostatistics and Computational Biology, Harvard School of Public Health, Boston, Massachusetts
| | - Jennifer R. Bellon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Harvey Mamon
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Anthony V. D’Amico
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Brian M. Alexander
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
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19
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Taylor JM, Song A, Nowak K, Dan T, Simone B, Harrison A, Doyle L, Lockamy V, Anne P, Simone N. Dosimetric Comparisons of Simulation Techniques for Left-Sided Breast Cancer in the COVID-19 Era: Techniques to Reduce Viral Transmission and Respect the Therapeutic Ratio. Cureus 2021; 13:e13354. [PMID: 33747655 PMCID: PMC7968704 DOI: 10.7759/cureus.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The COVID-19 pandemic challenges our ability to safely treat breast cancer patients and requires revisiting current techniques to evaluate optimal strategies. Potential long-term sequelae of breast radiation have been addressed by deep inspiration breath-hold (DIBH), prone positioning, and four-dimensional computed tomography (4DCT) average intensity projection (AveIP)-based planning techniques. Dosimetric comparisons to determine the optimal technique to minimize the normal tissue dose for left-sided breast cancers have not been performed. Methods Ten patients with left-sided, early-stage breast cancer undergoing whole breast radiation were simulated in the prone position, supine with DIBH, and with a free-breathing 4DCT scan. The target and organs at risk (OAR) contours were delineated in all scans. Target volume coverage and OAR doses were assessed. One-way analysis of variance (ANOVA) and Kruskal-Wallis one-way ANOVA were used to detect differences in dosimetric parameters among the different treatment plans. Significance was set as p < 0.05. Results We demonstrate differences in heart and lung dose by the simulation technique. The mean heart doses in the prone, DIBH, and AveIP plans were 129 cGy, 154 cGy, and 262 cGy, respectively (p=0.02). The lung V20 in the prone, DIBH, and AveIP groups was 0.5%, 10.3% and 9.5%, respectively (p <0.001). Regardless of technique, lumpectomy planning target volume (PTV) coverage did not differ between the three plans with 95% of the lumpectomy PTV volume covered by 100.4% in prone plans, 98.5% in AveIP plans, and 99.3% in DIBH plans (p=0.7). Conclusions Prone positioning provides dosimetric advantages as compared to DIBH. When infection risks are considered as in the current coronavirus disease 2019 (COVID-19) pandemic, prone plans have advantages in reducing the risk of disease transmission. In instances where prone positioning is not feasible, obtaining an AveIP simulation may be useful in more accurately assessing heart and lung toxicity and informing a risk/benefit discussion of DIBH vs free breath-hold techniques.
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Affiliation(s)
- James M Taylor
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Andrew Song
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Kamila Nowak
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Tu Dan
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Brittany Simone
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Amy Harrison
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Laura Doyle
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Virginia Lockamy
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Pramila Anne
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Nicole Simone
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, USA
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Vahabi N, Salehi M, Duarte JD, Mollalo A, Michailidis G. County-level longitudinal clustering of COVID-19 mortality to incidence ratio in the United States. Sci Rep 2021; 11:3088. [PMID: 33542313 PMCID: PMC7862666 DOI: 10.1038/s41598-021-82384-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023] Open
Abstract
As of November 12, 2020, the mortality to incidence ratio (MIR) of COVID-19 was 5.8% in the US. A longitudinal model-based clustering system on the disease trajectories over time was used to identify "vulnerable" clusters of counties that would benefit from allocating additional resources by federal, state and county policymakers. County-level COVID-19 cases and deaths, together with a set of potential risk factors were collected for 3050 U.S. counties during the 1st wave of COVID-19 (Mar25-Jun3, 2020), followed by similar data for 1344 counties (in the "sunbelt" region of the country) during the 2nd wave (Jun4-Sep2, 2020), and finally for 1055 counties located broadly in the great plains region of the country during the 3rd wave (Sep3-Nov12, 2020). We used growth mixture models to identify clusters of counties exhibiting similar COVID-19 MIR growth trajectories and risk-factors over time. The analysis identifies "more vulnerable" clusters during the 1st, 2nd and 3rd waves of COVID-19. Further, tuberculosis (OR 1.3-2.1-3.2), drug use disorder (OR 1.1), hepatitis (OR 13.1), HIV/AIDS (OR 2.3), cardiomyopathy and myocarditis (OR 1.3), diabetes (OR 1.2), mesothelioma (OR 9.3) were significantly associated with increased odds of being in a more vulnerable cluster. Heart complications and cancer were the main risk factors increasing the COVID-19 MIR (range 0.08-0.52% MIR↑). We identified "more vulnerable" county-clusters exhibiting the highest COVID-19 MIR trajectories, indicating that enhancing the capacity and access to healthcare resources would be key to successfully manage COVID-19 in these clusters. These findings provide insights for public health policymakers on the groups of people and locations they need to pay particular attention while managing the COVID-19 epidemic.
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Affiliation(s)
- Nasim Vahabi
- Informatics Institute, University of Florida, Gainesville, FL, USA
| | - Masoud Salehi
- Department of Biostatistics, College of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Julio D Duarte
- Center for Pharmacogenomics, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Abolfazl Mollalo
- Department of Public Health and Prevention Sciences, School of Health Sciences, Baldwin Wallace University, Berea, OH, USA
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21
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How COVID-19 Pandemics Changed the Treatment Protocols for Patients with Gynecological Tumors. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
It was found that oncological patients are4 to 8 times more likely of developing severe forms of COVID-19 infection than other patients, so mortality is higher in patients with gyneco-logical cancer. Due to this pandemic, reported delays in diagnosis and treatment of genital cancer and changes in disease management, may influence the natural history of neoplasm. This fact adds more stress and fear for patients with neoplasms. Adequate protective measures are essen-tial for SARS CoV2 infection avoidance and lead to changes in healthcare professionals clinical practice. Prioritization is important, but direct personal interactions should be limited. However, gynecological tumors surgery, chemotherapy, and radiotherapy should continue as high priority practices, without essential modification. The conclusion is that COVID-19 pandemic has affect-ed many guides for management of diseases, especially oncological. Adaptations in clinical prac-tice may avoid viral infection and reduce mortality and severe complications.
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22
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Chhabra AM, Chowdhary M, Choi JI, Hasan S, Press RH, Simone CB. A National Survey of Radiation Oncology Experiences Completing Tele-Consultations During the Coronavirus Disease (COVID-19) Pandemic. Adv Radiat Oncol 2021; 6:100611. [PMID: 33458451 PMCID: PMC7803621 DOI: 10.1016/j.adro.2020.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The emergence of the coronavirus disease (COVID-19) global pandemic has led to a significant shift in the delivery of health care, including an explosive growth of telemedicine services. This reverberated in the field of radiation oncology, with a recent American Society for Radiation Oncology (ASTRO) nationwide survey reporting 89% of surveyed clinics began to offer telemedicine programs to patients because of the pandemic. However, this survey did not study the perceptions and experiences of those clinicians delivering telemedicine services. Methods and Materials We investigated through a national physician survey the merits and limitations of radiation oncology tele-consultations. An anonymous web-based survey was distributed using SurveyMonkey (www.surveymonkey.com) via email. Results Seventy six respondents (16.1% overall response rate) completed the survey, with broad representation from both academic and community-based practices. Many respondents agreed that transitioning to tele-consultations was a needed step given the emergence of the pandemic, despite most having never previously offered this service. Despite many radiation oncologists having little prior experience with tele-consultations, a majority were satisfied in being able to explain the details of a medical diagnosis, provide results of imaging and bloodwork, and discuss recommendations around radiation treatments through this format. Nearly half of the respondents agreed that tele-consultations felt impersonal, with the inability to complete physical examinations noted as a contributor to the impersonality. Nevertheless, respondents still agreed that telemedicine will play an important role going forward, and almost 90% agreed that they would offer tele-consultations even after the pandemic has resolved.
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Affiliation(s)
- Arpit M. Chhabra
- New York Proton Center, New York City, New York
- Corresponding author: Arpit Chhabra, MD
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23
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Bowen SC, Gheewala R, Paez W, Lucke-Wold B, Mitin T, Ciporen JN. Telemedicine visits in an established multidisciplinary central nervous system clinic for radiation oncology and neurosurgery (RADIANS) in a community hospital setting. BRATISL MED J 2021; 122:680-683. [PMID: 34463116 PMCID: PMC8425713 DOI: 10.4149/bll_2021_109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic. METHODS Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data. RESULTS A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), women (9) and men (16), repeat telemedicine visits n=10, malignant CNS disease (17) and benign disease (5). Mean one-way distance traveled was 165.07 miles (median=114; range=0.8-358). Mean roundtrip travel time was estimated at 5h 5min. Mean telemedicine visit duration was 15.3 mins (range=4-46). Mean patient satisfaction score for telemedicine visits was 4.84. CONCLUSION Patients who opted for the telemedicine visits found them just as effective as in-person visits, saving time and travel costs as well as ensuring patient safety during the current COVID-19 pandemic. The telemedicine visit platform facilitates the multidisciplinary clinic model and should be considered for more widespread utilization (Tab. 3, Fig. 1, Ref. 18).
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Viscariello N, Evans S, Parker S, Schofield D, Miller B, Gardner S, Fong de Los Santos L, Hallemeier C, Jordan L, Kim E, Ford E. A multi-institutional assessment of COVID-19-related risk in radiation oncology. Radiother Oncol 2020; 153:296-302. [PMID: 33096163 PMCID: PMC7574842 DOI: 10.1016/j.radonc.2020.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE The COVID-19 pandemic has presented challenges to delivering safe and timely care for cancer patients. The oncology community has undertaken substantial workflow adaptations to reduce transmission risk for patients and providers. While various control measureshave been proposed and implemented, little is known about their impact on safety of the radiation oncology workflow and potential for transmission. The objective of this study was to assess potential safety impacts of control measures employed during the COVID-19 pandemic. METHODS A multi-institutional study was undertaken to assess the risks of pandemic-associated workflow adaptations using failure mode and effects analysis (FMEA). Failure modes were identified and scored using FMEA formalism. FMEA scores were used to identify highest-risk aspects of the radiation therapy process. The impact of control measures on overall risk was quantified. Agreement among institutions was evaluated. RESULTS Thirty three failure modes and 22 control measures were identified. Control measures resulted in risk score reductions for 22 of the failure modes, with the largest reductions from screening of patients and staff, requiring use of masks, and regular cleaning of patient areas. The median risk score for all failure modes was reduced from 280 to 168. There was high institutional agreement for 90.3% of failure modes but only 47% of control measures. CONCLUSIONS COVID-related risks are similar across oncology practices in this study. While control measures can reducerisk, their use varied. The effectiveness of control measures on risk may guide selection of the highest-impact workflow adaptions to ensure safe care in oncology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Eric Ford
- University of Washington, Seattle, USA
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25
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Tsatsakis A, Calina D, Falzone L, Petrakis D, Mitrut R, Siokas V, Pennisi M, Lanza G, Libra M, Doukas SG, Doukas PG, Kavali L, Bukhari A, Gadiparthi C, Vageli DP, Kofteridis DP, Spandidos DA, Paoliello MMB, Aschner M, Docea AO. SARS-CoV-2 pathophysiology and its clinical implications: An integrative overview of the pharmacotherapeutic management of COVID-19. Food Chem Toxicol 2020; 146:111769. [PMID: 32979398 PMCID: PMC7833750 DOI: 10.1016/j.fct.2020.111769] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
Common manifestations of COVID-19 are respiratory and can extend from mild symptoms to severe acute respiratory distress. The severity of the illness can also extend from mild disease to life-threatening acute respiratory distress syndrome (ARDS). SARS-CoV-2 infection can also affect the gastrointestinal tract, liver and pancreatic functions, leading to gastrointestinal symptoms. Moreover, SARS-CoV-2 can cause central and peripheral neurological manifestations, affect the cardiovascular system and promote renal dysfunction. Epidemiological data have indicated that cancer patients are at a higher risk of contracting the SARS-CoV-2 virus. Considering the multitude of clinical symptoms of COVID-19, the objective of the present review was to summarize their pathophysiology in previously healthy patients, as well as in those with comorbidities. The present review summarizes the current, though admittedly fluid knowledge on the pathophysiology and symptoms of COVID-19 infection. Although unclear issues still remain, the present study contributes to a more complete understanding of the disease, and may drive the direction of new research. The recognition of the severity of the clinical symptoms of COVID-19 is crucial for the specific therapeutic management of affected patients.
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Affiliation(s)
- Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece; I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia.
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
| | - Luca Falzone
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori "Fondazione G. Pascale", 80131, Naples, Italy.
| | - Dimitrios Petrakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece.
| | - Radu Mitrut
- Department of Cardiology, University and Emergency Hospital, 050098, Bucharest, Romania.
| | - Vasileios Siokas
- Department of Neurology, University of Thessaly, University Hospital of Larissa, 41221, Larissa, Greece.
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy.
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123, Catania, Italy; Department of Neurology IC, Oasi Research Institute-IRCCS, 94018, Troina, Italy.
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123, Catania, Italy; Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123, Catania, Italy.
| | - Sotirios G Doukas
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003, Heraklion, Greece; Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- University of Pavol Josef Safarik University, Faculty of Medicine, Kosice, Slovakia.
| | - Leena Kavali
- Department of Internal Medicine, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, NJ, 08901, USA.
| | - Amar Bukhari
- Department of Medicine, Division of Pulmonary and Critical Care 240 Easton Ave, Adult Ambulatory at Cares Building 4th Floor, New Brunswick, NJ, 08901, USA.
| | - Chiranjeevi Gadiparthi
- Division of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peter's University Hospital, New Brunswick, NJ, USA.
| | - Dimitra P Vageli
- Department of Surgery, The Yale Larynx Laboratory, New Haven, CT, 06510, USA.
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece.
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, 71003, Greece.
| | - Monica M B Paoliello
- Department of Molecular Pharmacology, Albert Eisntein College of Medicine, 1300 Morris Park Avenue Bronx, NY, 10461, USA.
| | - Michael Aschner
- I.M. Sechenov First Moscow State Medical University (Sechenov University), 119146, Moscow, Russia; Department of Molecular Pharmacology, Albert Eisntein College of Medicine, 1300 Morris Park Avenue Bronx, NY, 10461, USA.
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349, Craiova, Romania.
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Boettcher AN, Hammoud DA, Weinberg JB, Agarwal P, Mendiratta-Lala M, Luker GD. Cancer Imaging and Patient Care during the COVID-19 Pandemic. Radiol Imaging Cancer 2020; 2:e200058. [PMID: 33778750 PMCID: PMC7706101 DOI: 10.1148/rycan.2020200058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Patients with cancer have been negatively impacted during the coronavirus disease 2019 (COVID-19) pandemic, as many of these individuals may be immunosuppressed and of older age. Additionally, cancer follow-up or imaging appointments have been delayed in many clinics around the world. Postponement of routine screening exams will result in delays in new cancer diagnoses. Clinics are continuing to monitor and adapt their appointment schedules based on local outbreaks of COVID-19. Studies on COVID-19 in patients with cancer are limited, but consistently indicate that this population is at risk for more severe COVID-19 illness. Data from recent studies also suggest that pediatric patients with cancer have a lower risk of severe COVID-19 illness compared to adults. Certain features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected by lung, brain, and gastrointestinal imaging may confound radiologists' interpretation of cancer diagnosis, staging, and treatment response. Lastly, as clinics begin to re-open for routine appointments, protocols have been put in place to reduce SARS-CoV-2 exposure to patients during their visits. This review details different perspectives on the impact of the COVID-19 pandemic on patients with cancer and on cancer imaging. Keywords: Abdomen/GI, Cardiac, Infection, Nervous-Peripheral.
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Affiliation(s)
- Adeline N. Boettcher
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Dima A. Hammoud
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Jason B. Weinberg
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Prachi Agarwal
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Mishal Mendiratta-Lala
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
| | - Gary D. Luker
- From the Scientific Editor, RSNA (A.N.B.); Center for Infectious Disease Imaging, NIH Clinical Center, Bethesda, Maryland (D.A.H.); Departments of Pediatrics and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (J.B.W.); Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan (P.A.); Department of Radiology, Division of Abdominal imaging, University of Michigan, Ann Arbor, Michigan (M.M.); Department of Radiology, Biomedical Engineering, and Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan (G.D.L)
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Gutkin PM, Minneci MO, Valenton J, Kovalchuk N, Chang DT, Horst KC. Importance of a Culture Committee for Boosting Morale and Maintaining a Healthy Work Environment in Radiation Oncology. Adv Radiat Oncol 2020; 5:1115-1117. [PMID: 32838068 PMCID: PMC7368646 DOI: 10.1016/j.adro.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 12/02/2022] Open
Abstract
During the unprecedented workplace disruption from the corona virus disease 2019 (COVID-19) pandemic, health care workers have been particularly vulnerable to increased work-related stress and anxiety. This may have a negative effect on job performance and personal well-being. Personal safety, job security, and childcare needs are essential concerns that must be addressed by health care organizations to ensure stability of its workforce. In addition, workplace morale is also damaged by the many daily changes brought about by social distancing. Thus, opportunities exist for departments to address the loss of social bonding and cohesiveness needed for successful team building. In this report, we describe the efforts of our departmental workplace culture committee during this pandemic.
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Affiliation(s)
- Paulina M. Gutkin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Madeline O. Minneci
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - John Valenton
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Division of Physics, Stanford University School of Medicine, Stanford, California
| | - Daniel T. Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Kathleen C. Horst
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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28
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Patt D, Gordan L, Diaz M, Okon T, Grady L, Harmison M, Markward N, Sullivan M, Peng J, Zhou A. Impact of COVID-19 on Cancer Care: How the Pandemic Is Delaying Cancer Diagnosis and Treatment for American Seniors. JCO Clin Cancer Inform 2020; 4:1059-1071. [PMID: 33253013 PMCID: PMC7713534 DOI: 10.1200/cci.20.00134] [Citation(s) in RCA: 358] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE While the immediate care and access disruptions associated with the COVID-19 pandemic have received growing attention in certain areas, the full range of gaps in cancer screenings and treatment is not yet well understood or well documented throughout the country comprehensively. METHODS This study used a large medical claims clearinghouse database representing 5%-7% of the Medicare fee-for-service population to characterize changes in the utilization of cancer care services and gain insight into the impact of COVID-19 on the US cancer population, including identification of new patients, gaps in access to care, and disruption of treatment journeys. RESULTS In March-July 2020, in comparison with the baseline period of March-July 2019, there is a substantial decrease in cancer screenings, visits, therapy, and surgeries, with variation by cancer type and site of service. At the peak of the pandemic in April, screenings for breast, colon, prostate, and lung cancers were lower by 85%, 75%, 74%, and 56%, respectively. Significant utilization reductions were observed in April for hospital outpatient evaluation and management (E&M) visits (-74%), new patient E&M visits (-70%), and established patient E&M visits (-60%). A decrease in billing frequency was observed for the top physician-administered oncology products, dropping in both April (-26%) and July (-31%). Mastectomies were reduced consistently in April through July, with colectomies similarly reduced in April and May and prostatectomies dipping in April and July. CONCLUSION The current impact of the COVID-19 pandemic on cancer care in the United States has resulted in decreases and delays in identifying new cancers and delivery of treatment. These problems, if unmitigated, will increase cancer morbidity and mortality for years to come.
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Affiliation(s)
| | - Lucio Gordan
- Florida Cancer Specialists & Research Institute LLC, Gainesville, FL
| | - Michael Diaz
- Florida Cancer Specialists & Research Institute LLC, Gainesville, FL
| | - Ted Okon
- Community Oncology Alliance, Monroe, CT
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29
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Fuller CD, van Dijk LV, Thompson RF, Scott JG, Ludmir EB, Thomas CR. Meeting the Challenge of Scientific Dissemination in the Era of COVID-19: Toward a Modular Approach to Knowledge-Sharing for Radiation Oncology. Int J Radiat Oncol Biol Phys 2020; 108:496-505. [PMID: 32890543 PMCID: PMC7462881 DOI: 10.1016/j.ijrobp.2020.06.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas; Department of Radiation Medicine, Oregon Health & Science University, Oregon.
| | - Lisanne V van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas; Department of Radiation Oncology, University Medical Center- Groningen, Groningen, Netherlands
| | - Reid F Thompson
- Department of Radiation Medicine, Oregon Health & Science University, Oregon
| | - Jacob G Scott
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer, Houston, Texas
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Oregon
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30
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Martinez D, Sarria GJ, Wakefield D, Flores C, Malhotra S, Li B, Ehmann M, Schwartz DL, Sarria GR. COVID's Impact on Radiation Oncology: A Latin American Survey Study. Int J Radiat Oncol Biol Phys 2020; 108:374-378. [PMID: 32890516 PMCID: PMC7462756 DOI: 10.1016/j.ijrobp.2020.06.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The impact of the COVID-19 pandemic on Latin American radiation therapy services has not yet been widely assessed. In comparison to centers in Europe or the United States, the scarcity of data on these terms might impair design of adequate measures to ameliorate the pandemic's potential damage. The first survey-based analysis revealing regional information is herein presented. METHODS AND MATERIALS From May 6 to May 30, 2020, the American Society for Radiation Oncology's COVID-19 Survey was distributed across Latin America with support of the local national radiation therapy societies. Twenty-six items, including facility demographic and financial characteristics, personnel and patient features, current and expected impact of the pandemic, and research perspectives, were included in the questionnaire. RESULTS Complete responses were obtained from 115 (50%) of 229 practices across 15 countries. Only 2.6% of centers closed during the pandemic. A median of 4 radiation oncologists (1-27) and 9 (1-100) radiation therapists were reported per center. The median number of new patients treated in 2019 was 600 (24-6200). A median 8% (1%-90%) decrease in patient volume was reported, with a median of 53 patients (1-490) remaining under treatment. Estimated revenue reduction was 20% or more in 53% of cases. Shortage of personal protective equipment was reported in 51.3% of centers, and 27% reported personnel shortage due to COVID-19. Reported delays in treatment for low-risk entities included early stage breast cancer (42.6%), low-risk status prostate cancer (67%), and nonmalignant conditions (42.6%). Treatment of COVID-19 patients at designated treatment times and differentiated bunkers were reported in 22.6% and 10.4% of centers, respectively. Telehealth initiatives have been started in 64.3% of facilities to date for on-treatment (29.6%) and posttreatment (34.8%) patients. CONCLUSIONS Regional information regarding COVID-19 pandemic in Latin America may help elucidate suitable intervention strategies for personnel and patients. Follow-up surveys will be performed to provide dynamic monitoring the pandemic's impact on radiation therapy services and adoption of ameliorating measures.
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Affiliation(s)
- David Martinez
- Department of Radiation Oncology, Oncosalud-AUNA, Lima, Peru; Rayos Contra Cancer, Inc, Nashville, Tennessee
| | - Gustavo J Sarria
- Department of Radiation Oncology, Oncosalud-AUNA, Lima, Peru; Department of Radiotherapy, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Daniel Wakefield
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Department of Radiation Oncology, The University of Tennessee Health Science Center, Memphis, Tennessee; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Claudio Flores
- Department of Statistics and Translational Investigation, Oncosalud-AUNA, Lima, Peru
| | - Sameeksha Malhotra
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Vanderbilt University, Nashville, Tennessee
| | - Benjamin Li
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Michael Ehmann
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - David L Schwartz
- Department of Radiation Oncology, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gustavo R Sarria
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany.
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31
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Keramati MR, Behboudi B, Ahmadi-Tafti SM, Kazemeini A, Keshvari A, Salahshour F, Aghili M, Alborzi F, Aletaha N, Babaei M, Bangash MN, Ebrahimi-Daryani N, Emami AH, Farhan F, Haddad P, Kalani M, Naseri A, Shahi F, Fazeli MS. Management of colon and rectal cancers during COVID-19 pandemic: A clinical guideline (TUMS-CRC-CoV19 Guideline). Med J Islam Repub Iran 2020; 34:128. [PMID: 33437724 PMCID: PMC7787015 DOI: 10.34171/mjiri.34.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Indexed: 02/07/2023] Open
Abstract
Background: In a resource-demanding COVID-19 pandemic, guidelines can free up health care resources needed for providing better care to those with COVID-19 and other patients. This study was performed to design a guideline to manage patients with colorectal cancers during the COVID-19pandemic.
Methods: To design this guideline, major topics and headings of colon and rectal cancers (CRC) were selected and included. Based on the extent of COVID-19 infection in the community and availability of hospital resources, the guideline has been designed for 2 major COVID-19 phases. Several multidisciplinary discussion sessions were held to review the comments of experts, finalize the data, and write the guideline.
Results: This guideline has been prepared in 2 main COVID-19 phases of the community/hospital. Phase A refers to the condition where a large number of COVID-19 patients are admitted to the hospital, but limited surgical ICU beds and facilities are still accessible. In phase B, many people are affected by COVID-19, and all hospital resources are allocated for COVID 19 patients. In phase A, 4 major groups are discussed, including malignant and suspicious colorectal polyps, colon cancers, rectal cancers, and recurrent cancers. The approach to emergent cases, including obstruction, bleeding, and perforation, will be presented in phase B.
Conclusion: This guideline is a comprehensive instruction on the approach to colorectal cancers during the COVID-19 pandemic that covers the major topics of colon and rectal cancers in detail.
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Affiliation(s)
- Mohammad Reza Keramati
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Behboudi
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Ahmadi-Tafti
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Kazemeini
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Keshvari
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Aghili
- Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Foroogh Alborzi
- Division of Gastroenterology, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Aletaha
- Division of Gastroenterology, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Babaei
- Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Naeem Bangash
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Ebrahimi-Daryani
- Division of Gastroenterology, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Emami
- Department of Hematology and Medical Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshid Farhan
- Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Peiman Haddad
- Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kalani
- Division of Gastroenterology, Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhosein Naseri
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahi
- Department of Hematology and Medical Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Fazeli
- Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Skinner HD. Mining the past to treat the present, ever mindful of the future: Low-dose radiotherapy and COVID-19 pneumonia. Cancer 2020; 126:5017-5021. [PMID: 32985700 PMCID: PMC7536983 DOI: 10.1002/cncr.33201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022]
Abstract
This editorial discusses an interim analysis of the clinical trial by Hess et al. The trial examines the use of low‐dose radiotherapy in the treatment of patients with coronavirus disease 2019 (COVID‐19) pneumonia.
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Affiliation(s)
- Heath D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
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33
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Jazieh AR, Chan SL, Curigliano G, Dickson N, Eaton V, Garcia-Foncillas J, Gilmore T, Horn L, Kerr DJ, Lee J, Mathias C, Nogueira-Rodrigues A, Pierce L, Rogado A, Schilsky RL, Soria JC, Warner JL, Yoshida K. Delivering Cancer Care During the COVID-19 Pandemic: Recommendations and Lessons Learned From ASCO Global Webinars. JCO Glob Oncol 2020; 6:1461-1471. [PMID: 32997537 PMCID: PMC7529523 DOI: 10.1200/go.20.00423] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In response to the COVID-19 pandemic, the ASCO launched a Global Webinar Series to address various aspects of cancer care during the pandemic. Here we present the lessons learned and recommendations that have emerged from these webinars. METHODS Fifteen international health care experts from different global regions and oncology disciplines participated in one of the six 1-hour webinars to discuss the latest data, share their experiences, and provide recommendations to manage cancer care during the COVID-19 pandemic. These sessions include didactic presentations followed by a moderated discussion and questions from the audience. All recommendations have been transcribed, categorized, and reviewed by the experts, who have also approved the consensus recommendations. RESULTS The summary recommendations are divided into different categories, including risk minimization; care prioritization of patients; health care team management; virtual care; management of patients with cancer undergoing surgical, radiation, and systemic therapy; clinical research; and recovery plans. The recommendations emphasize the protection of patients and health care teams from infections, delivery of timely and appropriate care, reduction of harm from the interruption of care, and preparation to handle a surge of new COVID-19 cases, complications, or comorbidities thereof. CONCLUSION The recommendations from the ASCO Global Webinar Series may guide practicing oncologists to manage their patients during the ongoing pandemic and help organizations recover from the crisis. Implementation of these recommendations may improve understanding of how COVID-19 has affected cancer care and increase readiness to manage the current and any future outbreaks effectively.
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Affiliation(s)
- Abdul Rahman Jazieh
- King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Stephen L. Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Giuseppe Curigliano
- Istituto Europeo di Oncologia, IRCCS and University of Milano, Milano, Italy
| | | | | | - Jesus Garcia-Foncillas
- Department of Oncology, Oncohealth Institute, Fundacion Jimenez Diaz University Hospital, Autonomous University, Madrid, Spain
| | | | | | | | | | | | | | - Lori Pierce
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
| | - Alvaro Rogado
- ECO Foundation for Excellence and Quality in Oncology, Madrid, Spain
| | | | | | | | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University, Graduate School of Medicine, Gifu, Japan
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Bice N, Kirby N, Bahr T, Rasmussen K, Saenz D, Wagner T, Papanikolaou N, Fakhreddine M. Deep learning-based survival analysis for brain metastasis patients with the national cancer database. J Appl Clin Med Phys 2020; 21:187-192. [PMID: 32790207 PMCID: PMC10081512 DOI: 10.1002/acm2.12995] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/25/2020] [Accepted: 06/24/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Prognostic indices such as the Brain Metastasis Graded Prognostic Assessment have been used in clinical settings to aid physicians and patients in determining an appropriate treatment regimen. These indices are derivative of traditional survival analysis techniques such as Cox proportional hazards (CPH) and recursive partitioning analysis (RPA). Previous studies have shown that by evaluating CPH risk with a nonlinear deep neural network, DeepSurv, patient survival can be modeled more accurately. In this work, we apply DeepSurv to a test case: breast cancer patients with brain metastases who have received stereotactic radiosurgery. METHODS Survival times, censorship status, and 27 covariates including age, staging information, and hormone receptor status were provided for 1673 patients by the NCDB. Monte Carlo cross-validation with 50 samples of 1400 patients was used to train and validate the DeepSurv, CPH, and RPA models independently. DeepSurv was implemented with L2 regularization, batch normalization, dropout, Nesterov momentum, and learning rate decay. RPA was implemented as a random survival forest (RSF). Concordance indices of test sets of 140 patients were used for each sample to assess the generalizable predictive capacity of each model. RESULTS Following hyperparameter tuning, DeepSurv was trained at 32 min per sample on a 1.33 GHz quad-core CPU. Test set concordance indices of 0.7488 ± 0.0049, 0.6251 ± 0.0047, and 0.7368 ± 0.0047, were found for DeepSurv, CPH, and RSF, respectively. A Tukey HSD test demonstrates a statistically significant difference between the mean concordance indices of the three models. CONCLUSION Our results suggest that deep learning-based survival prediction can outperform traditional models, specifically in a case where an accurate prognosis is highly clinically relevant. We recommend that where appropriate data are available, deep learning-based prognostic indicators should be used to supplement classical statistics.
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Affiliation(s)
- Noah Bice
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Neil Kirby
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Tyler Bahr
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Karl Rasmussen
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Daniel Saenz
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Timothy Wagner
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Niko Papanikolaou
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
| | - Mohamad Fakhreddine
- Department of Radiological SciencesUT Health San AntonioSan AntonioTX78229USA
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Rathod S, Dubey A, Bashir B, Sivananthan G, Leylek A, Chowdhury A, Koul R. Bracing for impact with new 4R's in the COVID-19 pandemic - A provincial thoracic radiation oncology consensus. Radiother Oncol 2020; 149:124-127. [PMID: 32342864 PMCID: PMC7141475 DOI: 10.1016/j.radonc.2020.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/08/2023]
Abstract
As COVID-19 pandemic continues to explode, cancer centers worldwide are trying to adapt and are struggling with this constantly changing scenario. Intending to ensure patient safety and deliver quality care, we sought consensus on the preferred thoracic radiation regimen in a Canadian province with 4 new R's of COVID era.
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Affiliation(s)
- Shrinivas Rathod
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Arbind Dubey
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ahmet Leylek
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amitava Chowdhury
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
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Elledge CR, Beriwal S, Chargari C, Chopra S, Erickson BA, Gaffney DK, Jhingran A, Klopp AH, Small W, Yashar CM, Viswanathan AN. Radiation therapy for gynecologic malignancies during the COVID-19 pandemic: International expert consensus recommendations. Gynecol Oncol 2020; 158:244-253. [PMID: 32563593 PMCID: PMC7294297 DOI: 10.1016/j.ygyno.2020.06.486] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To develop expert consensus recommendations regarding radiation therapy for gynecologic malignancies during the COVID-19 pandemic. METHODS An international committee of ten experts in gynecologic radiation oncology convened to provide consensus recommendations for patients with gynecologic malignancies referred for radiation therapy. Treatment priority groups were established. A review of the relevant literature was performed and different clinical scenarios were categorized into three priority groups. For each stage and clinical scenario in cervical, endometrial, vulvar, vaginal and ovarian cancer, specific recommendations regarding dose, technique, and timing were provided by the panel. RESULTS Expert review and discussion generated consensus recommendations to guide radiation oncologists treating gynecologic malignancies during the COVID-19 pandemic. Priority scales for cervical, endometrial, vulvar, vaginal, and ovarian cancers are presented. Both radical and palliative treatments are discussed. Management of COVID-19 positive patients is considered. Hypofractionated radiation therapy should be used when feasible and recommendations regarding radiation dose, timing, and technique have been provided for external beam and brachytherapy treatments. Concurrent chemotherapy may be limited in some countries, and consideration of radiation alone is recommended. CONCLUSIONS The expert consensus recommendations provide guidance for delivering radiation therapy during the COVID-19 pandemic. Specific recommendations have been provided for common clinical scenarios encountered in gynecologic radiation oncology with a focus on strategies to reduce patient and staff exposure to COVID-19.
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Affiliation(s)
- Christen R Elledge
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Beth A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Small
- Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Catheryn M Yashar
- Department of Radiation Oncology, University of California San Diego, San Diego, CA, USA
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Abstract
BACKGROUND Amidst the COVID-19 pandemic, management of cancer has been one of the most intensely debated topics across the globe. We conducted an online survey to determine the consistency/or the lack of it, in the management of sarcoma patients between centres and the changes in policies. METHODS A twenty-five question online survey was conducted among practicing physicians over a period of 10 days using online portal (surveymonkey.com). It was followed by a critical analysis based on responses to each question. RESULTS Of 194 medical professionals who participated, 80% were surgeons and 53% were working in government institutes. Most respondents (81%) continued their practice with some modifications. In OP majority (67%) relied only on symptom, contact enquiry and temperature recording for screening. COVID-19 testing was done more (43%) in IP patients. Most of institutes (83%) followed rotational policy to reduce the number of staff at risk while 57% offered an alternate accommodation. 52.3% continued chemotherapy for all patients while radiotherapy for all was offered by 45%. In metastatic cases, majority preferred either no treatment or non-surgical intervention (71%).84.5% believed in adapting changes (42%-avoid supra major surgeries, 27%-Operating only emergency cases and 15.5%-High grade sarcomas with curative intent) in surgical management of sarcomas. For benign bone tumors, majority (71%) agreed on adapting changes while 25% agreed on deferring all cases. 69% preferred teleconsultations for follow-up. Complete PPE were being used for all aerosol generating procedures by 44%. Only two thirds agreed with their institutes policy of PPE usage and COVID-19 testing. CONCLUSION This survey has highlighted disparity on COVID-19 screening and management in various institutes across the country. This will act as a reference point for tracking future trends in bone and soft tissue tumor management guidelines, as the COVID-19 scenario unfolds globally and particularly in India.
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38
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Riegel AC, Chou H, Baker J, Antone J, Potters L, Cao Y. Development and execution of a pandemic preparedness plan: Therapeutic medical physics and radiation dosimetry during the COVID-19 crisis. J Appl Clin Med Phys 2020; 21:259-265. [PMID: 32652862 PMCID: PMC7497914 DOI: 10.1002/acm2.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 12/30/2022] Open
Abstract
The SARS‐CoV‐2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID‐19, the illness associated with the SARS‐CoV‐2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on‐site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID‐19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6‐week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high‐quality, efficient care while minimizing risk to the staff by minimizing on‐site presence. Currently, the number of COVID‐19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID‐19 return or an unknown virus manifest in the future.
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Affiliation(s)
- Adam C Riegel
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Henry Chou
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Jameson Baker
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jeffrey Antone
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Yijian Cao
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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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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Marcus DM, Weathers WM, Rossi PJ. Computed Tomography in Radiation Oncology During the Coronavirus Disease 2019 Pandemic. Adv Radiat Oncol 2020; 5:757-760. [PMID: 32775789 PMCID: PMC7305504 DOI: 10.1016/j.adro.2020.06.003] [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: 04/23/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, cancer centers must implement effective measures to protect patients and staff from infection with the novel coronavirus. A critical component of this effort is the timely identification of patients undergoing treatment who have COVID-19. Limitations on testing make such efforts challenging. However, the specialty of radiation oncology is unique in its use of computed tomography (CT) imaging for image guidance, and these CT studies have the potential to identify patients with COVID-19 even before they develop symptoms. Several organizations have developed published guidelines for radiologists to identify characteristic findings of COVID-19 on thoracic CT scans. The present article describes these recommendations in order to educate radiation oncologists on how to identify potential cases of COVID-19 and empower physicians in our field to optimally protect patients and staff.
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Affiliation(s)
- David M. Marcus
- Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, Colorado
| | | | - Peter J. Rossi
- Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs, Colorado
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41
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Chua ML, Ma DJ, Anderson CM, Karam SD, Margalit DN, Kimple RJ. Follow-Up and Management of Patients With Head and Neck Cancer During the 2019 Novel Coronavirus (SARS-CoV-2) Disease Pandemic. Adv Radiat Oncol 2020; 5:631-636. [PMID: 32426556 PMCID: PMC7227497 DOI: 10.1016/j.adro.2020.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore and Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Carryn M. Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Anschutz Cancer Center, Aurora, Colorado
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Randall J. Kimple
- Department of Human Oncology, UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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42
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Mo A, Brodin NP, Tomé WA, Garg MK, Kabarriti R. COVID-19 Incidentally Detected on PET/CT During Work-up for Locally Advanced Head and Neck Cancer. In Vivo 2020; 34:1681-1684. [PMID: 32503829 DOI: 10.21873/invivo.11961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022]
Abstract
AIM To describe the incidental detection of COVID-19 disease on positron-emission tomography/computed tomography (PET/CT) in a patient with cancer despite initial negative swab by polymerase chain reaction (PCR). CASE REPORT Clinical and radiographic data were obtained from the electronic medical record. Nasopharyngeal swabs were obtained and evaluated for COVID-19 by the Food and Drug Administration-approved reverse transcription-PCR assays. On radiographic examination, PET/CT was consistent with COVID-19-related pneumonia not seen on prior imaging. Initial nasopharyngeal swab 2 days after PET/CT imaging was negative for COVID-19. Subsequent repeat swab 10 days later was positive for COVID-19, while the patient was febrile on screening assessment. The patient remained COVID-19-positive until 1 month after abnormal PET/CT imaging. CONCLUSION PET/CT can be sensitive for early COVID-19 detection, even in the setting of a negative confirmatory PCR test. This highlights the importance of continued patient surveillance and use of appropriate personal protective equipment to minimize COVID-19 transmission.
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Affiliation(s)
- Allen Mo
- Department of Radiation Oncology, Montefiore Medical Center, New York, NY, U.S.A
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center, New York, NY, U.S.A.,Institute for Onco-Physics, Albert Einstein College of Medicine, New York, NY, U.S.A
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center, New York, NY, U.S.A.,Institute for Onco-Physics, Albert Einstein College of Medicine, New York, NY, U.S.A
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center, New York, NY, U.S.A.,Institute for Onco-Physics, Albert Einstein College of Medicine, New York, NY, U.S.A
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, New York, NY, U.S.A. .,Institute for Onco-Physics, Albert Einstein College of Medicine, New York, NY, U.S.A
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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: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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44
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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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Rathod S, Dubey A, Chowdhury A, Bashir B, Koul R. A Call for a Radiation Oncology Model Based on New 4R's During the COVID-19 Pandemic. Adv Radiat Oncol 2020; 5:608-609. [PMID: 32363246 PMCID: PMC7195347 DOI: 10.1016/j.adro.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Shrinivas Rathod
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amitava Chowdhury
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bashir Bashir
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- CancerCare Manitoba and University of Manitoba, Winnipeg, Manitoba, Canada
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Mohindra P, Buckey CR, Chen S, Sio TT, Rong Y. Radiation therapy considerations during the COVID-19 Pandemic: Literature review and expert opinions. J Appl Clin Med Phys 2020; 21:6-12. [PMID: 32324950 PMCID: PMC7286011 DOI: 10.1002/acm2.12898] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Courtney R Buckey
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Shifeng Chen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Yi Rong
- Department of Radiation Oncology, University of California-Davis Cancer Center, Sacramento, CA, USA
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47
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Hanna E. How fragile we are. Head Neck 2020; 42:1125-1130. [PMID: 32342575 DOI: 10.1002/hed.26199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Ehab Hanna
- Department of Head and Neck Surgery, Center Medical Directory, Head and Neck Center, University of Texas, MD Anderson Cancer Center, Houston, Texas
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48
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Chaudhari S, Sharma SD, Shrivastava SK. Revision in Standard Operating Procedures of Radiation Oncology Department and Quality Assurance Schedule under COVID-19 Pandemic. J Med Phys 2020; 45:130-133. [PMID: 32831496 PMCID: PMC7416866 DOI: 10.4103/jmp.jmp_37_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/23/2020] [Accepted: 06/06/2020] [Indexed: 01/24/2023] Open
Affiliation(s)
- Suresh Chaudhari
- Department of Radiation Oncology, Apollo Hospitals, Navi Mumbai, Maharashtra, India
| | - Sunil Dutt Sharma
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
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49
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Starling MTM, Silva ARNDSE, Pereira APA, Ferreira Neto DR, Restini FCF, Brito LHD, Souza TYTD, Hanna SA. Recommendations for radiotherapy during the novel coronavirus pandemic. Rev Assoc Med Bras (1992) 2020; 66:359-365. [PMID: 32520158 DOI: 10.1590/1806-9282.66.3.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Samir Abdallah Hanna
- . Médico titular do departamento de Radio-oncologia do Hospital Sírio-Libanês, São Paulo Brasil . Autor correspondente
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Agarwal J, Mummudi N, Tibdewal A, Ghosh-Laskar S. COVID-19 pandemic: Radiotherapy precautions and preparedness. J Cancer Res Ther 2020; 16:634-637. [DOI: 10.4103/jcrt.jcrt_405_20] [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]
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