ABSTRACT
Material and Methods: More than 93% of brachytherapy cases in our clinic are planned and treated in one session. This informed our historical staffing paradigm requiring two physics staff for each of these cases, and one staff for the remaining 7%. In March 2020, our region experienced a surge of COVID-19 cases resulting in a reduction in brachytherapy cases, followed by an immediate return to an almost full clinical case load in May, while social distancing and other precautions were enforced. A review of our policy and procedures was initiated in April to assess if a reduction in on-site staffing (0, 1, or 2 on-site physics staff per case) was possible while still maintaining safety and complying with regulatory requirements. A comparison between brachytherapy safety events related to physics coverage, physics planning, physics QA or physics treatment supervision reported to our internal reporting system in the time period 12/1/2019-2/28/2019 and 1/4/2021-1/7/2021 was analyzed. Results: Case load and distribution is shown in Figure 1a. A review of our case load revealed that 67% (intra-operative LDR & HDR prostate using a standalone planning platform) required 2 on-site staff members (Fig 1b). We established remote planning support for the remining 33% of cases. Requirements for remote planning included reliable remote internet access to clinical systems, video conferencing with onsite physicist and physician, and explicit assignment of roles and responsibilities for each staff. We implemented remote planning and remote plan checking procedures, as per review. Video conferencing proved to be an essential component of this process: allowing for direct communication between team members both improved communication and kept onsite staff (Physicians, OR nurses, etc.) informed of progress of remote tasks. Tasks that are less time sensitive, such as documentation and billing, were assigned to remote staff. All pre-planned cases (6% of total cases) were planned and checked remotely, with communications via email and Aria care-paths. No increase in relevant brachytherapy event was observed, even accounting for difference in number of cases. Conclusions: We have successfully implemented remote physics coverage for various brachytherapy cases in response to a public health COVID-19 emergency. The analysis of this experience will inform our staffing decision to permit the continuation of some remote work options after the COVID-19 emergency is resolved. [Formula presented]
ABSTRACT
Background: Recent reports highlight the higher incidence of severe events in cancer patients (pts) affected by COVID-19, although, insufficient data are available about the association with immunotherapy. Italian scientific society and colleges (AIOM, CIPOMO, COMU) released shared recommendations according to pts risk of infection and tumor characteristics, demanding for telephone consultations and, if suitable, treatments delay. Material and Methods: In Modena and Reggio Emilia Cancer Centers, medical reports of pts undertaking immunotherapy between January 1st 2020 and April 30th 2020 were collected. For those pts infected with COVID-19, identified by thoracic computerized tomography criteria and RT-PCR of nasopharyngeal specimens according to WHO indications, we estimated the risk of infection and related complications that lead to hospitalization. Results: A total of 337 pts with solid tumors treated with anti-PD1 and anti-PDL-1 antibody regardless the line of treatment was identified. Cancer diagnosis included 156 (46,3%) lung cancer, 74 (22%) melanoma, 36 (10,7%) kidney, 23 (7%) colorectal, 12 (3,4%) head and neck, and, 36 (10,6%) miscellaneous. Only 3 pts (0.9%), all with metastatic disease and during first line therapy were hospitalized for COVID-19 infection (Table1). The median age was 57 years. 2 pts have been treated with immunotherapy in combination with chemotherapy, and 1 patient with anti-PD1 and anti-CTLA-4. The onset symptom was fever in 2 pts, while 1 patient had subjective dyspnea. Subsequently, they develop respiratory distress and underwent to non-invasive assisted ventilation, receiving treatments with hydroxychloroquine, steroids, low molecular weight heparin. Tocilizumab was administered only in 1 patient according to progressive increase of serum IL-6 values. Nobody was admitted in Intensive Care Unit (ICU). Since the last update, May 15th 2020, 1 patient died while the others have recovered resulting COVID-19 negative to nasopharyngeal swab. Conclusions: Although not conclusive, in our series, cancer pts infected by COVID-19 receiving immunotherapy do not appear to be exposed to greater risk of recovery.
ABSTRACT
Background: Higher incidence of severe events in cancer pts affected by COVID-19 have been reported. However, the association with oncological treatments is not clear yet. Recommendations have been released by Italian scientific society and colleges (AIOM, CIPOMO, COMU) according to the risk of infection and tumor characteristics, suggesting telephone consultations and, if suitable, treatments delay. Methods: In Modena and Reggio Emilia Cancer Centers, previous Ethical Committee approval, medical reports of pts undertaking immunotherapy between January 1st - April 30th 2020 were collected. According to WHO indications COVID-19 infection was identified by thoracic CT scan and RT-PCR of nasopharyngeal specimens. For those pts we estimated the risk of infection and complications that lead to hospitalization. Results: A total of 337 pts with solid tumors treated with anti-PD1/PDL-1 antibody regardless the line of treatment was identified. Cancer diagnosis included 156 (46,3%) lung, 74 (22%) melanoma, 36 (10,7%) kidney, 23 (7%) colorectal, 12 (3,4%) head and neck, 36 (10,6%) miscellaneous. Only 3 pts (0.9%), with advanced disease and in first line therapy were hospitalized for COVID-19 (Table). The onset symptom was fever in 2 pts, and subjective dyspnea in 1 pt. Subsequently, they develop respiratory distress and underwent to non-invasive assisted ventilation, receiving hydroxychloroquine, steroids, low molecular weight heparin. Tocilizumab was administered in 1 pt due to progressive increase of serum IL-6 values. Nobody was admitted in Intensive Care Unit. Since the last update, May 15th 2020, 1 pt died;the others have recovered with negative nasopharyngeal swab. [Formula presented] Conclusions: Although not conclusive, in our series, cancer pts infected by COVID-19 receiving immunotherapy do not appear to be exposed to greater risk of recovery. Legal entity responsible for the study: Angela Damato. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.