Minimize impact of pandemic on radiation oncology department: Experience from a moderate-sized regional cancer program in the battle against COVID-19 virus

Introduction: The World Health Organization (WHO) declared COVID-19 virus as pandemic on March 12, 2020 Now it has infected more than 5 million people in 188 countries and caused more than 340,000 deaths The purposeof this paper is to share the experience of our radiation oncology department in a moderate-sized regional cancercenter (1,600 new consults for radiation per year) in the battle against COVID-19, including the safety measurestaken and the lessons learned Methods: Our institution is located in the neighbor city of one of the largest COVID-19 epicenters in the USA Wehave taken precautionary measures gradually to continue our practice in radiation oncology in order to reduceimpact on vulnerable cancer patients These include reducing the number of entrance doors for both staff andpatients;restricted visitor policy;mandatory screening questionnaires;social distancing in waiting rooms;self-quarantine of staff with travel history or symptoms similar to COVID-19;most responsible physicians reviewingevery case to prioritize or defer consultation, investigation, or treatment;telemedicine for most consultation andfollow-up visits;universal COVID-19 swabbing test for all symptomatic and asymptomatic cancer patients beforestarting treatment planning or radiotherapy;full personal protective equipment (PPE) for staff doing CT simulation ordelivering treatment;mandatory face mask for everyone in the building;keeping 2/3 of all radiation oncologists (RO) and dosimetrists working from home on a roster schedule;and discouraging handling physical paper charts anddocuments in a completely paperless working environment Results: We saw 267 new consults in the 10 weeks between March 16 and May 24, 2020, vs 274 in the sameperiod last year There is no significant difference in average consults per RO, 44 5 (30-60) vs 45 7 (24-67), p=0 799 (Student's t-test), or wait time within provincial target of 2 weeks, 93 5% vs 97%, p=0 074 We performed193 swabbing tests for 183 patients, with 10 patients bein g swabbed twice Most were asymptomatic (144), with 49symptomatic Only 0 52% tested positive (1 asymptomatic case), lower than many other cancer institutions reportedin the literature, and there were no cases among staff During the same 10 weeks, confirmed cases in ourcommunity and the province increased from 0 to 912 (6 05% positive tests) and from 142 to 25,904 (4 18% positivetests), with 63 and 2,102 deaths, respectively Conclusions: Due to restrictions to test asymptomatic patients and to use PPE, the COVID-19 testing rate is farfrom reaching the provincial target and the new cases and deaths are more than originally predicted However, ourdepartment was not heavily affected due to the diligent team effort ahead of policy changes in the province It ispossible for frontline health care teams to minimize the risk of cancer patients getting COVID-19 and avoidtreatment interruptions by planning safety measures early, even before the first case in the community and beforeformal provincial guidelines become available