Impact of COVID-19 on Gynecologic Oncology Care: A Survey of Practicing Gynecologic Radiation Oncologists in the United States

Purpose The COVID-19 pandemic has placed demands and limitations on the delivery of healthcare. Here we sought to assess the impact of COVID-19 on the delivery of gynecologic oncologic care, from the perspective of practicing radiation oncologists in the United States. Materials and Methods An anonymous online survey was created and distributed to pre-identified U.S. radiation oncologists with clinical expertise in the management of gynecologic patients. The survey consisted of demographic questions followed by directed questions to assess specific patterns of care related to the COVID-19 pandemic. Results A total of 47 of 96 invited radiation oncologists responded to the survey for a response rate of 49%. 56% of respondents reported an increase in locally advanced cervical cancer with no similar increase for endometrial, vulvar or vaginal patients. The majority (66%) reported a pause in surgical management with a duration of 1-3 months being most common (61%). There was a reported increased utilization of shorter brachytherapy regimens during the pandemic. Most (61%) providers reported caring for at least one COVID positive patient. A pause or delay in treatment due to COVID-19 positivity was reported by 45%, with 55% reporting that patients chose to delay their own care because of COVID related concerns. Total treatment times of greater than 8 weeks for cervical cancer patients were observed by 33%, but this occurred in less than 25% of their cervical cancer patients. Conclusion Data from this prospectively collected anonymous survey of practice patterns among radiation oncologists reveal that the COVID pandemic resulted in delays initiating care, truncated brachytherapy treatment courses and a reported increase in locally advanced cervical cancer cases at presentation. These data can be utilized as a means of "self-assessment” to ensure appropriate decision making for gynecologic patients during the endemic phase of COVID.

Effect of COVID-19 on Gynecologic Oncology Care: A Survey of Practicing Gynecologic Radiation Oncologists in the United States.

Purpose: The COVID-19 pandemic has placed demands and limitations on the delivery of health care. We sought to assess the effect of COVID-19 on the delivery of gynecologic oncologic care from the perspective of practicing radiation oncologists in the United States. Methods and Materials: An anonymous online survey was created and distributed to preidentified radiation oncologists in the United States with clinical expertise in the management of gynecologic patients. The survey consisted of demographic questions followed by directed questions to assess specific patterns of care related to the COVID-19 pandemic. Results: A total of 47 of 96 invited radiation oncologists responded to the survey for a response rate of 49%. Fifty-six percent of respondents reported an increase in locally advanced cervical cancer with no similar increase for endometrial, vulvar, or vaginal patients. Most respondents (66%) reported a pause in surgical management, with a duration of 1 to 3 months being most common (61%). There was a reported increased use of shorter brachytherapy regimens during the pandemic. Most providers (61%) reported caring for at least 1 patient with a positive COVID-19 test. A pause or delay in treatment due to COVID-19 positivity was reported by 45% of respondents, with 55% reporting that patients chose to delay their own care because of COVID-19-related concerns. Total treatment times >8 weeks for patients with cervical cancer were observed by 33% of respondents, but occurred in >25% of patients. Conclusions: Data from this prospectively collected anonymous survey of practice patterns among radiation oncologists reveal that the COVID-19 pandemic resulted in delays initiating care, truncated brachytherapy treatment courses, and a reported increase in locally advanced cervical cancer cases at presentation. These data can be used as a means of self-assessment to ensure appropriate decision making for gynecologic patients during the endemic phase of COVID-19.

Evaluation of burnout in physician members of the American Brachytherapy Society.

PURPOSE: To evaluate the prevalence of burnout among brachytherapy specialists and to identify factors associated with burnout. METHODS AND MATERIALS: An anonymous, online, cross-sectional survey was administered to non-trainee physician members of the American Brachytherapy Society. Burnout was evaluated using the validated Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Demographic and practice-specific questions were collected from respondents. Univariate and multivariable analysis of outcomes were performed using probabilistic index models. RESULTS: Overall, 51 of 400 physicians responded (13% response rate). Fifty-seven percent of respondents demonstrated at least one symptom of professional burnout. However, only 6% of respondents met strict criteria for high burnout. Analysis of the individual MBI-HSS subdomains demonstrated higher subscale scores for emotional exhaustion and depersonalization, but also higher scores for personal accomplishment. On multivariable analysis after adjusting for increased feelings of burnout due to the COVID-19 pandemic or total hours of work per week, younger age was associated with both increased subscale scores for emotional exhaustion (p = 0.026) and lower personal accomplishment (p = 0.010). Lastly, nearly half of all respondents (47%) reported increased feelings of burnout due to the COVID-19 pandemic. Respondents from academic facilities were significantly more likely to report increased burnout due to COVID-19 compared to those from non-academic facilities (odds ratio, 7.04; 95% CI 1.60-31.0; p = 0.010). CONCLUSIONS: Nearly 60% of brachytherapists demonstrated symptoms of professional burnout, which is higher than other radiation oncology groups (academic chairs, program directors, residents). Managing stressors related to workload, COVID and support for junior physicians are potential areas for improving feelings of burnout.

Evaluating an Ultraviolet C System for Use During SARS-CoV2 Pandemic and Personal Protective Equipment Shortage.

PURPOSE: The supply of N95 masks and filtering facepiece respirators (FFRs) has been limited nationally owing to the coronavirus disease 2019 pandemic. Ultraviolet C (UVC) light has been suggested as a potential option for decontamination of FFRs by the Centers for Disease Control. There has been a lack of publications characterizing UVC dose distribution across FFRs. METHODS AND MATERIALS: A UVC light box and FFR rack system was assembled using low-pressure mercury lamps peaked at 254 nm and aluminum flashing to reduce shadowing effect. Dose was characterized with the use of ultraviolet (UV) intensity labels and an ultraviolet germicidal irradiation (UVGI) National Institute of Standards and Technology traceable meter. Ozone production was evaluated after extended bulb run time. RESULTS: Calibration of UV intensity labels was noted to have color-change saturation at 100 mJ/cm2. Dose measurements with the UV intensity labels on the FFR demonstrated symmetrical dose to all surfaces, but symmetry was not supported by measurements with the UVGI meter. There was substantial dose fall off on the lateral aspects of the FFR. No ozone production was noted in the UVC system. CONCLUSIONS: UV intensity labels for characterization of dose provided a false suggestion of symmetry compared with the UVGI meter. Estimates of appropriate exposure times to reach 1000 mJ/cm2 should be significantly increased to account for geometry of FFR and lateral dose fall off.

The Case for Brachytherapy: Why It Deserves a Renaissance.

The recent global events related to the coronavirus disease of 2019 pandemic have significantly changed the medical landscape and led to a shift in oncologic treatment perspectives. There is a renewed focus on preserving treatment outcomes while maintaining medical accessibility and decreasing medical resource utilization. Brachytherapy, which is a vital part of the treatment course of many cancers (particularly prostate and gynecologic cancers), has the ability to deliver hypofractionated radiation and thus shorten treatment time. Studies in the early 2000s demonstrated a decline in brachytherapy usage despite data showing equivalent or even superior treatment outcomes for brachytherapy in disease sites, such as the prostate and cervix. However, newer data suggest that this trend may be reversing. The renewed call for shorter radiation courses based on data showing equivalent outcomes will likely establish hypofractionated radiation as the standard of care across multiple disease sites. With shifting reimbursement, brachytherapy represents the pinnacle in hypofractionated, conformal radiation therapy, and with extensive long-term data in support of the treatment modality brachytherapy is primed for a renaissance.

COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation.

PURPOSE: The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS: We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS: There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS: Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.