In conclusion

AN ADVISORY BY ASSOCIATION OF RADIATION ONCOLOGISTS OF INDIA (AROI) FOR RADIATION THERAPY PATIENTS AND STAFF AMIDST COVID 19 PANDEMIC

 

Cancer patients are more susceptible to infection because of the following reasons

  • Undergoing treatment in form of chemotherapy, radiotherapy, immunotherapy, targeted therapy
  • Patients with hematological malignancies
  • Transplant patients on immunosuppressive therapy
  • Elderly cancer patients with medical co morbidities

 

In order to contain the spread of novel  COVID 19 some precautionary measures are required to be taken

 

How Do You Suspect A COVID 19 Case

 

A patient with fever & cough and breathing difficulty with

  • Contact with suspected & confirmed COVID19 cases in last few weeks
  • Travelled to any of the countries where local transmission going on (WHO document)
  • Healthcare worker caring for a confirmed COVID19 pts
  • Severe pneumonia or ARDS
  • A person living in same household as COVID 19 case or direct contact with COVID 19 case without proper PPE
  • Face to face contact with COVID 19 case within 1 meter or closed environment like airplane or closed room gatherings

 

Directive To Patients

  • Follow social distancing
  • Stay at home as much as possible
  • Avoid crowded areas
  • Wash your hands frequently and correctly with a soap/ sanitizer
  • Consider delaying your palliative radiotherapy if it is only for minor symptom relief and has no impact on outcome or disease control
  • Elderly patients especially with symptoms are at highest risk and extra precaution should be taken

 

Directives To Healthcare Professionals

 

General Measures

  • Provide clean and spacious waiting area with adequate distance between Chairs
  • Provide mask and hand hygiene aids like sanitizer, hand-wash, gloves at outpatient area
  • Protocol for temperature and vitals checking for patients
  • Special care to suspected/vulnerable patients by dedicated & trained staff
  • Protocol for COVID 19 screening & isolation
  • All international travelers should submit self declaration form which can be submitted at the counters
  • Certain countries are high transmission countries and travelers from those countries are advised to undergo 14 days self quarantine from date of arrival
  • All such suspected patients should be handled as per institutional policies and guidelines / help lines provided by government

 

Minimize Personal contact Via

  • Telephonic/video consultation
  • Postpone elective post treatment follow up
  • Prioritize appointments
  • Schedule timely appointments & stick to time to decrease patient waiting
  • Report seen online / electronically without personal visits to the department

 

 

 

At OPD Consultation

  • Maintain at least one meter distance between care taker & any patient who is coughing/sneezing
  • Take detailed history of recent travel to COVID 19 infected area or close contact with a person infected with corona virus
  • Check for any symptoms of viral infection in all patients

 

For Department Staff

  • Clean, trained & dedicated staff
  • Shift postings
  • Staff separated by time & location
  • Provide safety measures like gloves, masks, aprons for all staff
  • Screening of staff

 

Decision about cancer treatment

  • Prioritize treatment to most in need
  • Delay treatment in low priority patient
  • The benefit of cancer treatment should be assessed over the risk & complications of COVID 19 infection

 

 

 

ADVISORY FOR RADIATION TREATMENTS

 

Categorization of patients

 

 

 
   

 

  1. Priority High :patients. undergoing radiation with radical intent for cure in which delay in treatment onset may jeopardize outcome

 

  1. Priority Moderate : radical radiotherapy for less aggressive tumors or urgent palliative RT like in patients with malignant spinal cord compression to avoid neurological damage

 

  1. Priority Low : Radiation in an adjuvant setting where a complete resection of disease with good margins and less than 15 -20 percent risk of recurrence over 10 years and pts with less aggressive tumors where radiation is a part of treatment protocol but can be postponed owing to low risk category & slow growth of tumor.

 

 

  Treatment Related Measures

  • use of biologically equivalent dose hypofractionated schedule to minimize hospital visits
  • delay treatment of elective low grade, low risk tumors like breast & prostate
  • minimize use of accessories involving physical contact
  • any accessory if contaminated should be sent for testing & decontamination
  • categorize follow up based on priority of disease

 

 

 

Conclusion

At some point a consideration to be made to the point that in future it may be possible that the availability of services/treating personnel may be compromised.

In such cases patients would like to discuss such situations with the caregivers & the caregivers should have clear plan of prioritizing treatment

 

                                        Complied by –

                                                  Dr. Kaustav Talpatra
Head Department of Radiation Oncology

                                                              Kokila ben Hospital.Mumbai