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1.
Lancet Oncol ; 23(1): e21-e31, 2022 01.
Article in English | MEDLINE | ID: covidwho-1586210

ABSTRACT

High-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-based radiotherapy.


Subject(s)
Advisory Committees/standards , Breast Neoplasms/radiotherapy , Dose Fractionation, Radiation , Patient Selection , Radiation Oncology/standards , Breast Neoplasms/pathology , COVID-19/epidemiology , Consensus , Europe , Evidence-Based Medicine , Female , Humans , Radiation Dose Hypofractionation
3.
Radiol Med ; 126(2): 343-347, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-834039

ABSTRACT

OBJECTIVES: The objective of the paper was to assess real-life experience in the management of head and neck cancer (HNC) patients during the COVID-19 pandemic in radiotherapy departments and to evaluate the variability in terms of adherence to American Society of Radiation Oncology (ASTRO) and European Society for Radiotherapy and Oncology (ESTRO) recommendations. MATERIALS AND METHODS: In May 2020, an anonymous 30-question online survey, comparing acute phase of outbreak and pre-COVID-19 period, was conducted. Two sections exploited changes in general management of HNC patients and different HNC primary tumors, addressing specific statements from ASTRO ESTRO consensus statement as well. RESULTS: Eighty-eight questionnaires were included in the demographic/clinical workflow analysis, and 64 were analyzed for treatment management. Forty-eight percent of radiotherapy departments became part of oncologic hubs. First consultations reduced, and patients were addressed to other centers in 33.8 and 18.3% of cases, respectively. Telematic consultations were used in 50% of follow-up visits and 73.9% of multidisciplinary tumor board discussions. There were no practical changes in the management of patients affected by different primitive HNCs. Hypofractionation was not favored over conventional schedules. CONCLUSIONS: Compared to pre-COVID era, the clinical workflow was highly re-organized, whereas there were no consistent changes in RT indications and schedules.


Subject(s)
COVID-19/epidemiology , Head and Neck Neoplasms/radiotherapy , Pandemics , Radiation Oncology/statistics & numerical data , SARS-CoV-2 , Europe/epidemiology , Guideline Adherence/statistics & numerical data , Head and Neck Neoplasms/drug therapy , Health Care Surveys/statistics & numerical data , Humans , Induction Chemotherapy , Italy/epidemiology , Radiotherapy/methods , Radiotherapy/statistics & numerical data , Radiotherapy Dosage , Referral and Consultation/statistics & numerical data , Societies, Medical , Telemedicine/statistics & numerical data , Workflow
4.
Med Oncol ; 37(10): 85, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-716386

ABSTRACT

Management of patients with head and neck cancers (HNCs) is challenging for the Radiation Oncologist, especially in the COVID-19 era. The Italian Society of Radiotherapy and Clinical Oncology (AIRO) identified the need of practice recommendations on logistic issues, treatment delivery and healthcare personnel's protection in a time of limited resources. A panel of 15 national experts on HNCs completed a modified Delphi process. A five-point Likert scale was used; the chosen cut-offs for strong agreement and agreement were 75% and 66%, respectively. Items were organized into two sections: (1) general recommendations (10 items) and (2) special recommendations (45 items), detailing a set of procedures to be applied to all specific phases of the Radiation Oncology workflow. The distribution of facilities across the country was as follows: 47% Northern, 33% Central and 20% Southern regions. There was agreement or strong agreement across the majority (93%) of proposed items including treatment strategies, use of personal protection devices, set-up modifications and follow-up re-scheduling. Guaranteeing treatment delivery for HNC patients is well-recognized in Radiation Oncology. Our recommendations provide a flexible tool for management both in the pandemic and post-pandemic phase of the COVID-19 outbreak.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Head and Neck Neoplasms/radiotherapy , Medical Oncology/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , COVID-19 , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/epidemiology , Humans , Italy/epidemiology , Medical Oncology/methods , Pneumonia, Viral/epidemiology , Radiotherapy/methods , Radiotherapy/standards , SARS-CoV-2 , Societies, Medical/standards
7.
Clin Transl Radiat Oncol ; 24: 53-59, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-601923

ABSTRACT

INTRODUCTION: With the COVID-19 pandemic, individuals have been forced to follow strict social isolation guidelines. While crucial to control the pandemic, isolation might have a significant impact on productivity and mental health. Especially for researchers working in healthcare, the current situation is complex. We therefore carried out a survey amongst researchers in the field of radiation oncology to gain insights on the impact of social isolation and working from home and to guide future work. MATERIALS AND METHODS: An online survey was conducted between March 27th and April 5th, 2020. The first part contained 14 questions intended to capture an overview of the specific aspects related to research while in isolation. The second (optional) part of the questionnaire was the validated Hospital Anxiety and Depression Scale (HADS), a self-reported measure used to assess levels of anxiety and depressive symptoms. RESULTS: From 543 survey participants, 48.8% reported to work full-time from home. The impact on perceived productivity, with 71.2% of participants feeling less productive, caused 58% of participants to feel some level of guilt.Compared to normative data, relatively high levels of anxiety and depressive symptoms were recorded for the 335 participants who filled out the HADS questionnaire. Group comparisons found the presence of a supportive institutional program as the sole factor of statistical significance in both anxiety and depressive symptom levels. People having to work full-time on location showed higher depressive symptom levels than those working from home. Anxiety scores were negatively correlated with the number of research years. CONCLUSION: Results of the survey showed there is a non-negligible impact on both productivity and mental health. As the radiation oncology research community was forced to work from home during the COVID-19 pandemic, lessons can be learned to face future adverse situations but also to improve work-life balance in general.

8.
Biomed Res Int ; 2020: 4892382, 2020.
Article in English | MEDLINE | ID: covidwho-582357

ABSTRACT

SARS-CoV-2 pandemic and COVID-19 diffusion have recently become an international public health emergency. Cancer patients, as a frail population, are particularly exposed to the risk related to infections. The clinical decision-making process and the organizational workflow of radiotherapy department should be revised in the light of the critical situation. We herein provide practical suggestions derived from the available literature and discussed during an online session held within the e-learning educational program of the European School of Oncology on March 31st 2020.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Neoplasms/complications , Neoplasms/radiotherapy , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Radiation Oncologists , Breast Neoplasms/complications , Breast Neoplasms/radiotherapy , COVID-19 , Clinical Decision-Making , Female , Humans , Infection Control/methods , Radiation Oncology , SARS-CoV-2
9.
Radiother Oncol ; 149: 89-93, 2020 08.
Article in English | MEDLINE | ID: covidwho-269365

ABSTRACT

Italy experienced one of the world's deadliest COVID-19 outbreaks and healthcare systems had to instantly reorganise activity. The Italian Radiation Oncology Departments adapted numerous solutions to minimize the disruptions. Information technologies, treatment prioritization and implementation of hypofractionation and protection procedures allowed balancing between cancer patient care and patient/healthcare workers safety.


Subject(s)
Betacoronavirus , Coronavirus Infections , Medical Oncology , Neoplasms/radiotherapy , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/epidemiology , Disease Outbreaks , Humans , Italy/epidemiology , Medical Oncology/legislation & jurisprudence , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Surveys and Questionnaires
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