key: cord-0952324-jbwu21k1 authors: Samper Ots, Pilar M.; Zapatero Ortuño, José; Pedraza Fernández, Sara; Mayrata Canellas, Esther; González San Segundo, Carmen; Campo Vargas, Maider; Caballero, Begoña; Ramos Albiac, Mónica; Vazquez Masedo, Gonzalo; Álvarez, Beatriz; Rodriguez Villalba, Silvia; Muñoz Miguelañez, Teresa; Diezhandino Garcia, Patricia; Sancho, Gemma; Guzmán Gómez, Laura; Tripero, Juana; Rico Oses, Mikel; Ibañez Villoslada, Carmen; María Soler Rodríguez, Ana; Luisa Chust, María; Fondevilla Soler, Adriana; Maria Lozano Martin, Eva; Morillo Macias, Virginia; Fuentes Sánchez, Claudio; Torrado Moya, Laura; Fernández López, Jesús; Maria Solé, Josep; Guijarro Verdú, Marcos; Mira Flores, Moisés; Wals, Amadeo; Expósito Hernández, José title: Impact of covid-19 on patients in radiotherapy oncology departaments in spain date: 2021-06-10 journal: Radiother Oncol DOI: 10.1016/j.radonc.2021.06.001 sha: 96aa298d159572efbb3d8498e646175752211ead doc_id: 952324 cord_uid: jbwu21k1 nan On December 31, 2019 a cluster of cases of pneumonia were first described in Wuhan, caused by a novel type of coronavirus called SARS-CoV-2. This virus causes various clinical manifestations encompassed under the term COVID-19 i . On March 11, 2020 the World Health Organization declared COVID-19 a global pandemic ii . In Spain, the most critical period was between February 15 to May 15, 2020. During this time, various different case definitions were provided iii,iv . Initial data showed that patients with cancer are at highest risk of developing severe COVID-19 disease v . In this pandemic context, risks and benefits of receiving cancer treatment should be carefully weighted. Treatment RT delays and interruptions can negatively impact outcome and long-term survival. Another fact to consider is that in a ROD protective measures among staff and changes in its regular workflow must be implemented when treating COVID-19 patients vi . The objectives of this study are to analyze the incidence of COVID-19 in patients referred to RODs in Spain, subsequent treatment modifications and to determine death-related risk factors due to COVID-19. A retrospective, observational multicenter study was carried out by 66 ROD in Spain throughout a nationwide survey between February 15 and May 15, 2020. All patients scheduled for or in treatment were registered as well as those with a confirmed/suspected case of COVID-19 according to case definitions at the time 3 . Demographic data and information regarding COVID-19 infection, tumor and RT treatment was collected. SPSS statistical software package (v.22.0; IBM-SPSS; Chicago, IL; USA) was used. The study was approved by the Clinical Research Ethics Committee and is in compliance with Regulation (EU) 2016/679 on the protection of data. Between February 15 and May 15 2020, 39.848 patients were registered in all 66 RODs highest incidences were recorded in Madrid (2.2%) and the Basque Country (2%). Geographical distribution can be seen in the supplementary material. Complete data for 235 COVID-19 patients was provided and analyzed. Patient characteristics are shown in Table 1 . Patients mean age was 65  14 years. The most common symptoms were fever (63,4%), cough (42,6%) and dyspnea (31,6%). Chest radiographs were performed on 82% of patients, demonstrating pneumonia in 52%, bilateral in 37%. Reverse-transcription polymerase chain reaction assay was performed in 214 patients, with positive results in 146 patients (62%). Cases were classified as: confirmed (66,4%), discarded (15,7%), probable (8,1%) and suspicious (9,8%). The original treatment scheme was modified in 166 patients (70,6%). These treatment changes were: hypofractionation (6%), reduction of dose and/or total fractions (3%), suspension of systemic treatment (2%), RT suspension (15,3%), RT interruption (20,4%) and initiation delay (23,8%) . 118 patients (50,2%) completed treatment with no incidents, 33 (14%) completed RT with a higher overall treatment time, 42 (17,8%) patients completed RT treatment before expected (due to infection, toxicity or death). 10 patients (4,2%) successfully cured from COVID-19 but died due to tumor progression. 151 patients (64.3%) required hospital admission due to COVID-19 related complications, only 4 of which (2.6%) were admitted to the Intensive Care Units. 52 patients (mortality 22.1%) died due to COVID-19 or secondary complications. The incidence of COVID-19 in our study was 0.8%, 64,3% required hospital admission and COVID-19 mortality were 22,1%. In our study, death-related risk factors were advanced age, liver comorbidities, upper GI tract primary tumors, presence of brain metastases, palliative radiotherapy, dyspnea, pneumonia and elevated LDH levels. COVID-19 infection modified cancer treatment in 70,6%. In the univariant analysis (supplementary material), various prognostic factors for death were identified. The multivariate analysis is shown in Table 2 . COVID-19 incidence in cancer patients compared to the general population has been reported in various studies in China 1% vs 0,29%, vii in a Wuhan hospital 0,79% vs 0,37% viii and in Madrid 4,2% vs 0,63% ix . The prevalence of COVID-19 among cancer patients has been reported as 2.0% x . Patients with recent cancer diagnosis were at significantly increased risk for COVID 7.14) and had significantly worse outcomes with higher rates of hospitalization 47.46% and death 14.93% xi . The probability of death from COVID-19 in patients with cancer published in different studies is 25.6% xii , 28% xiii, 14 , 30.6%. 15 In the study by Mehta et al 13 . the risk factors for death were older age, higher composite comorbidity score, ICU admission, and elevated inflammatory markers (D-dimer, lactate, and LDH). In a prospective study xiv deathrelated risk factors were male, advanced age, hypertension and cardiovascular disease. Leukemia (OR 2.25) was also identified a death related risk factor in another study xv . In Given the severity of COVID-19 infection in these patients, it is important to avoid unnecessary visits to the hospital and promote remote visits when possible, a careful selection of patients that will benefit from radiotherapy as well as those in which treatment may be delayed or even omitted, and shortening of radiation therapy. xvii,xviii Multiple studies have proposed different hypofractionation schemes xix . In our study, only 6% of treatments were modified to a hypofractionation scheme, probably due to the fact that most guidelines and hypofractionation recommendations appeared after our inclusion period had concluded. xx, xxi, xxii Cancer patients are at higher risk of developing more severe cases of COVID-19 with increased mortality. Therefore, it is important optimize patient and treatment selection. In patients that will benefit from RT treatment and present mild symptoms, treatment shall be continued using hypofractionated schemes and proper protective measures. Between February 15 and May 15, 2020, 39.848 patients were either in treatment or ready to begin treatment in all 66 Radiation Oncology Departments in Spain. 329 cases of COVID-19 were declared, which represents an incidence of 0.8%. 64,3% required hospital admission and mortality due to COVID-19 was 22,1%. Cancer patients are at higher risk of developing more severe cases of COVID-19 with an increased mortality. Death-related risk factors were advanced age, hepatic comorbidity, upper GI tumor origin, presence of brain metastases, palliative radiotherapy, dyspnea, pneumonia and high levels of LDH. COVID-19 infection modified cancer treatment in 70,6%. Tumor progression-related death in COVID-19 patients was 4,2%. Given the increased mortality in these patients, it is important optimize patient and treatment selection. In patients that do benefit from treatment and present mild symptoms, treatment shall be continued using hypofractionated schemes and proper protective measures. Sara Pedraza Fernández. s.pedraza87@gmail.com Hospital 12 de Octubre Maider Campo Vargas. maider.campovargas@osakidetza.eus Hospital Begoña Caballero. begona.caballero@salud.madrid.org Hospital de Fuenlabrada Mónica Ramos Albiac monramos@vhebron.net Hospital de Vall d Gonzalo Vazquez Masedo mgonzalomv@yahoo.es Hospital Clinico de Madrid srodriguez@clinicabenidorm.com Hospital Clínica Teresa Muñoz Miguelañez. tere.miguelanez@gmail.com Hospital Ramón y Cajal es Hospital Mikel Rico Oses. Mikel.rico.oses@navarra.es Complejo Hospitalario de Navarra Ana María Soler Rodríguez. ana.solrod86@gmail.com Hospital Universitario de La Ribera Adriana Fondevilla Soler. adriana.fondevilla@genesiscare.es GenesisCare Murcia Claudio Fuentes Sánchez. cfuesan@gmail.com Hospital Universitario de la Candelaria ltorradomoya@gmail.com Hospital Universitario Lucus Augusti HULA. Galicia José Expósito Hernández. jose.exposito.hernandez@gmail.com Hospital Virgen de las Nieves Recomendaciones para el manejo, prevención y control de COVID-19 en los hospitales de día Onco-hematológicos y servicios de Oncología radioterápica. Versión de 30 de marzo de 2020. MINISTERIO DE SANIDAD. Gobierno de España. ii Coronavirus disease (COVID-19) outbreak. World Health Organization iii Procedimiento de actuación frente a casos de infección por el nuevo coronavirus (SARS-CoV-2) Actualizado a 15 de marzo de 2020 iv Estrategia de diagnóstico, vigilancia y control en la fase de transición de la pandemia de COVID-19 Enfermedad por coronavirus, COVID-19. 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