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Palliative radiotherapy indications during the COVID-19 pandemic and in future complex logistic settings: the NORMALITY model.
Cellini, Francesco; Di Franco, Rossella; Manfrida, Stefania; Borzillo, Valentina; Maranzano, Ernesto; Pergolizzi, Stefano; Morganti, Alessio Giuseppe; Fusco, Vincenzo; Deodato, Francesco; Santarelli, Mario; Arcidiacono, Fabio; Rossi, Romina; Reina, Sara; Merlotti, Anna; Jereczek-Fossa, Barbara Alicja; Tozzi, Angelo; Siepe, Giambattista; Cacciola, Alberto; Russi, Elvio; Gambacorta, Maria Antonietta; Scorsetti, Marta; Ricardi, Umberto; Corvò, Renzo; Donato, Vittorio; Muto, Paolo; Valentini, Vincenzo.
  • Cellini F; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italia. francesco.cellini@policlinicogemelli.it.
  • Di Franco R; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia. francesco.cellini@policlinicogemelli.it.
  • Manfrida S; Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy.
  • Borzillo V; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italia.
  • Maranzano E; Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy.
  • Pergolizzi S; Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy.
  • Morganti AG; Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
  • Fusco V; Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, Messina, Italy.
  • Deodato F; Radiation Oncology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy.
  • Santarelli M; DIMES, Alma Mater Studiorum - Bologna University, Bologna, Italy.
  • Arcidiacono F; Radiotherapy Oncology Department, IRCCS CROB, Rionero In Vulture, Italy.
  • Rossi R; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia.
  • Reina S; Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy.
  • Merlotti A; Radiotherapy Unit, Ospedale San Camillo de Lellis, Rieti, Italy.
  • Jereczek-Fossa BA; Radiation Oncology, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy.
  • Tozzi A; Palliative Care Unit IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Italy.
  • Siepe G; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italia.
  • Cacciola A; Struttura Complessa di Radioterapia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy.
  • Russi E; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
  • Gambacorta MA; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy.
  • Scorsetti M; Department of Radiation Oncology, ICS Maugeri SpA SB-IRCCS, Pavia, Italy.
  • Ricardi U; Radiation Oncology, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy.
  • Corvò R; Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università di Messina, Messina, Italy.
  • Donato V; Struttura Complessa di Radioterapia, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy.
  • Muto P; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, UOC di Radioterapia Oncologica, Roma, Italia.
  • Valentini V; Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia.
Radiol Med ; 126(12): 1619-1656, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1439752
ABSTRACT

INTRODUCTION:

The COVID-19 pandemic has challenged healthcare systems worldwide over the last few months, and it continues to do so. Although some restrictions are being removed, it is not certain when the pandemic is going to be definitively over. Pandemics can be seen as a highly complex logistic scenario. From this perspective, some of the indications provided for palliative radiotherapy (PRT) during the COVID-19 pandemic could be maintained in the future in settings that limit the possibility of patients achieving symptom relief by radiotherapy. This paper has two

aims:

(1) to provide a summary of the indications for PRT during the COVID-19 pandemic; since some indications can differ slightly, and to avoid any possible contradictions, an expert panel composed of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and the Palliative Care and Supportive Therapies Working Group (AIRO-palliative) voted by consensus on the summary; (2) to introduce a clinical care model for PRT [endorsed by AIRO and by a spontaneous Italian collaborative network for PRT named "La Rete del Sollievo" ("The Net of Relief")]. The proposed model, denoted "No cOmpRoMise on quality of life by pALliative radiotherapy" (NORMALITY), is based on an AIRO-palliative consensus-based list of clinical indications for PRT and on practical suggestions regarding the management of patients potentially suitable for PRT but dealing with highly complex logistics scenarios (similar to the ongoing logistics limits due to COVID-19). MATERIAL AND

METHODS:

First, a summary of the available literature guidelines for PRT published during the COVID-19 pandemic was prepared. A systematic literature search based on the PRISMA approach was performed to retrieve the available literature reporting guideline indications fully or partially focused on PRT. Tables reporting each addressed clinical presentation and respective literature indications were prepared and distributed into two main groups palliative emergencies and palliative non-emergencies. These summaries were voted in by consensus by selected members of the AIRO and AIRO-palliative panels. Second, based on the summary for palliative indications during the COVID-19 pandemic, a clinical care model to facilitate recruitment and delivery of PRT to patients in complex logistic scenarios was proposed. The summary tables were critically integrated and shuffled according to clinical presentations and then voted on in a second consensus round. Along with the adapted guideline indications, some methods of performing the first triage of patients and facilitating a teleconsultation preliminary to the first in-person visit were developed.

RESULTS:

After the revision of 161 documents, 13 papers were selected for analysis. From the papers, 19 clinical presentation items were collected; in total, 61 question items were extracted and voted on (i.e., for each presentation, more than one indication was provided from the literature). Two tables summarizing the PRT indications during the COVID-19 pandemic available from the literature (PRT COVID-19 summary tables) were developed palliative emergencies and palliative non-emergencies. The consensus of the vote by the AIRO panel for the PRT COVID-19 summary was reached. The PRT COVID-19 summary tables for palliative emergencies and palliative non-emergencies were adapted for clinical presentations possibly associated with patients in complex clinical scenarios other than the COVID-19 pandemic. The two new indication tables (i.e., "Normality model of PRT indications") for both palliative emergencies and palliative non-emergencies were voted on in a second consensus round. The consensus rate was reached and strong. Written forms facilitating two levels of teleconsultation (triage and remote visits) were also developed, both in English and in Italian, to evaluate the patients for possible indications for PRT before scheduling clinical visits.

CONCLUSION:

We provide a comprehensive summary of the literature guideline indications for PRT during COVID-19 pandemic. We also propose a clinical care model including clinical indications and written forms facilitating two levels of teleconsultation (triage and remote visits) to evaluate the patients for indications of PRT before scheduling clinical visits. The normality model could facilitate the provision of PRT to patients in future complex logistic scenarios.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Palliative Care / Radiation Oncology / COVID-19 / Neoplasms Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Europa Language: English Journal: Radiol Med Year: 2021 Document Type: Article Affiliation country: S11547-021-01414-z

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Palliative Care / Radiation Oncology / COVID-19 / Neoplasms Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Limits: Humans Country/Region as subject: Europa Language: English Journal: Radiol Med Year: 2021 Document Type: Article Affiliation country: S11547-021-01414-z