TY - JOUR
T1 - Mitigating the impact of COVID-19 on oncology
T2 - Clinical and operational lessons from a prospective radiation oncology cohort tested for COVID-19
AU - Ning, Matthew S.
AU - McAleer, Mary Frances
AU - Jeter, Melenda D.
AU - Minsky, Bruce D.
AU - Ghafar, Robert A.
AU - Robinson, Ivy J.
AU - Nitsch, Paige L.
AU - Zaebst, Denise J.
AU - Todd, Sarah E.
AU - Nguyen, Jennifer
AU - Lin, Steven H.
AU - Liao, Zhongxing
AU - Lee, Percy
AU - Gunn, G. Brandon
AU - Klopp, Ann H.
AU - Dabaja, Bouthaina S.
AU - Nguyen, Quynh Nhu
AU - Chronowski, Gregory M.
AU - Bloom, Elizabeth S.
AU - Koong, Albert C.
AU - Das, Prajnan
N1 - Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/7
Y1 - 2020/7
N2 - Background and purpose: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines. Materials and methods: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020–04/22/2020). Results: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1–4) to ≤1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75–5) to 1 business day (IQR: 1–2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3–6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2–11), with a peak of 17 employees simultaneously quarantined. Following implementation of a “dual PPE policy,” newly quarantined employees decreased from 2.9 to 0.5 per day. Conclusion: The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.
AB - Background and purpose: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines. Materials and methods: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020–04/22/2020). Results: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1–4) to ≤1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75–5) to 1 business day (IQR: 1–2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3–6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2–11), with a peak of 17 employees simultaneously quarantined. Following implementation of a “dual PPE policy,” newly quarantined employees decreased from 2.9 to 0.5 per day. Conclusion: The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.
KW - Acute respiratory distress syndrome
KW - Isolation precautions
KW - Nasopharyngeal swab
KW - Pandemic
KW - Quarantine
KW - SARS-CoV-2
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UR - http://www.scopus.com/inward/citedby.url?scp=85085941177&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2020.05.037
DO - 10.1016/j.radonc.2020.05.037
M3 - Article
C2 - 32474129
AN - SCOPUS:85085941177
SN - 0167-8140
VL - 148
SP - 252
EP - 257
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -