In conclusion



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






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





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