key: cord-321177-ywkkcagd
authors: Tamari, Keisuke; Nagata, Yasushi; Nishiki, Shingo; Nakamura, Satoaki; Ogawa, Kazuhiko; Uno, Takashi
title: Nationwide survey of COVID-19 prevention measures in Japanese radiotherapy departments via online questionnaire for radiation oncologists
date: 2020-05-29
journal: Radiother Oncol
DOI: 10.1016/j.radonc.2020.05.042
sha: 
doc_id: 321177
cord_uid: ywkkcagd

nan

Coronaviruses are pathogens that target the human respiratory system. Previous outbreaks of coronaviruses include severe acute respiratory syndrome (SARS) [1] and Middle East respiratory syndrome (MERS) [2] . In December, 2019, an outbreak of pneumonia of unknown cause was reported in Wuhan, China [3] . Chinese scientists rapidly identified the causative agent as a novel coronavirus (SARS-CoV-2) by sequencing the complete genome from lower respiratory tract samples of patients in Wuhan [4] . The WHO named this disease "coronavirus disease 2019" (COVID-19).

Having quickly spread around the world, COVID-19 is now a global health concern.

According to the WHO report, the top [5] . In Japan, the first patient with COVID-19 was detected on January 15, and the number of cases reached 12, 192 in Japan by April 23, 2020 [6] , which is relatively low compared to other countries, despite the early outbreaks. COVID-19 is now an important issue in Japanese radiotherapy departments. According to the DIRAC database, Japan has 800 radiotherapy centers, the third largest number in the world [7] . Chinese researchers report that cancer patients and cancer survivors are at increased risk of severe events 3 associated with COVID-19 compared to noncancer patients [8] . Additionally, cancer patients might have more chance to exposed to SARS-CoV-2 because they are supposed to receive radiotherapy every weekday for multiple weeks. For these patients, treatment would have to be discontinued for several weeks if they were to contract COVID-19, potentially leading to inferior treatment outcomes [9] . Therefore, COVID-19 prevention measures in radiotherapy departments are urgently needed to protect patients.

transmission-based precautions [10] . Careful adherence to the recommended IPC practices is known to decrease the transmission of infectious agents in healthcare settings [11, 12] . It was reported that suboptimal hand-washing, suboptimal hand hygiene before and after contact with patients, and improper personal protective equipment (PPE) were significant risk factors for COVID-19 infection among healthcare workers [13] . Radiation oncologists in Wuhan, China recently pointed out the importance of patient education and staff training to prevent infection in radiotherapy settings during the COVID-19 pandemic [14] . Whether radiotherapy departments in Japan are aware of and properly practice IPC measures is unknown.

Here, we investigate the current status of the practice of COVID-19 prevention measures in Japanese radiotherapy departments using an online questionnaire. 4 This study was approved by the academic committee of the Japanese Society for Radiation Oncology (JASTRO). The online questionnaire was developed using Google Forms (www.google.com/forms). The questions and answers were shown in Table 1 .

Our first version of the online questionnaire was distributed to radiation oncologists in The majority of the respondents (81.0%) indicated that they had taken some infection control measures for COVID-19. Proper hand hygiene was practiced at some but not all of the institutions, with 54.3% of the respondents reporting that patients 5 performed hand hygiene, 96.2% reporting that staff who had contact with patients performed hand hygiene, and 86.4% reporting that staff who did not have contact with patients performed hand hygiene. Only 50.5% of respondents indicated that all patients wore masks; 96.2% reported that all staff who had direct contact with patients wore masks, and 85.3% reported that all staff who had no direct contact with patients wore masks. Only 8.1% of the respondents reported that they used PPE in their radiotherapy practice. The number of respondents indicated that the radiotherapy clinic was ventilated was 58.7% for the examination room, 59.8% for the patient waiting room, 42.9% for the operation room, 49.5% for the staff room, and 20.7% for the treatment room. In addition, 63.0% of the respondents indicated that proper social distancing was maintained between patients, while fewer respondents reported such between staff at work (32.6%) or while on breaks (47.3%). These results indicated that there were differences in IPC measures for COVID-19 between radiotherapy departments. In addition, at this time, it was found that COVID-19 occurred in only one institution, and that COVID-19 had little impact on radiotherapy practice in Japan as a whole. Although the number of COVID-19 in Japan is relatively low compared to other countries, the impact of COVID-19 on radiotherapy should continue to be closely monitored.

This study has several limitations. While Japan has 800 radiotherapy centers, only 6 184 respondents participated in this study. These respondents might be radiation oncologists who were interested in COVID-19 prevention measures. If all radiation oncologists in Japan were asked to respond, the percentage of those taking measures to prevent COVID-19 might be even lower. Furthermore, some overlap in the responses may exist because the questionnaire response is not strictly limited to one respondent per institution. In order to overcome the limitations of our survey, JASTRO have decided to conduct periodic nationwide surveys of radiotherapy departments.

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