key: cord-1024460-n9nngs79
authors: Oliveira, Harley F.; Yoshinari, Gerson H.; Veras, Igor M.; de Almeida, Wilson J.; Freitas, Nilceana M.A.; Castilho, Marcus S.; de A. Pellizzon, Antônio C.; Erlich, Felipe; Affonso, Renato J.; de Carvalho, Ícaro T.; Leite, André C.C.; Kuhnen, Felipe Q.; Najas, Rosa M.X. F.; Rosa, Arthur Accioly
title: Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil Impact of COVID-19 on Brazilian Radiotherapy
date: 2021-02-06
journal: Adv Radiat Oncol
DOI: 10.1016/j.adro.2021.100667
sha: 0cc22cd0407cedaed81035c90cea52798d4cc637
doc_id: 1024460
cord_uid: n9nngs79

PURPOSE: The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. METHODS AND MATERIALS: The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. RESULTS: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions and other changes in daily practice. CONCLUSIONS: Thus, there was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic.

The Brazilian Radiotherapy Society (SBRT) developed a questionnaire for estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments (RO). These data were evaluated regarding cases confirmed and deaths by COVID-19 on July 11, 2020. 126 questionnaires were The COVID-19 pandemic declared by the World Health Organization (WHO), given the growing incidence and the complex repercussion observed in different social environments worldwide, requires comprehensive care for the population, especially those with associated comorbidities 1 . In this context, patients diagnosed with cancer have a higher risk of severe infections and mortality, especially during cancer treatment, in which they are in vulnerable conditions. The COVID-19 and Cancer Consortium (CCC19) 2 and Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) 3 ran studies with COVID-19 patients. They identified that patients with advanced age, male gender, impaired functional status, and associated comorbidities, such as hypertension, chronic lung disease, diabetes, and active cancer under treatment have a higher risk of morbidity and mortality [2] [3] [4] [5] .

To minimize the impact of the intense demand caused by the increase in the number of contaminants in the country, above its installed capacities, several contingency measures for health services have been proposed in order to guarantee access to patients with severe acute respiratory syndrome (SARS) caused by the new Coronavirus (SARS-CoV-2). Thus, medical care considered elective and those procedures of less complexity and low risk of aggravation were suspended in almost all health services in Brazil. However, even patients with a high suspicion of cancer had delayed diagnosis and treatment.

Universal and comprehensive health care is guaranteed by the Unified Health System (SUS). Still, the country is facing a restriction of access to public health due to insufficient resources and structure to meet the needs of the Brazilian population.

This structural deficiency made it challenging to face the COVID-19 pandemic and J o u r n a l P r e -p r o o f hampered the maintenance of essential health programs, such as cancer care. Also, about 22% of the country's population has additional assistance through supplementary private health insurance, managed by the private health sector 6 It was asked about the percentage drop in patient care during the pandemic period.

Considering the drop, about 59% of the services reported a reduction above 20%. Of these, about 14% reported a reduction above 50% of patients undergoing radiotherapy (Table 1 ). The reduction happened proportionally similar between the origin of the patients, with a decrease both in patients coming from supplementary private health insurance and SUS patients ( Table 2) . Table 3 . There has been a practice of rotation of assistance teams during the pandemic period. Questioned about the practice, forty-four services (34.9%) claimed to perform such rotation. 

Discussion:

The first case of COVID-19 in Brazil was registered on 02/25/2020. Since then, on 7/11/2020, after 135 days of the first case (epidemiological week 28), the country has In the survey carried out by SBRT, about 61% of services reported a reduction above 20%. Of these, about 14% reported a reduction above 50% of patients undergoing J o u r n a l P r e -p r o o f radiotherapy. In questionnaires for the European Radiation Oncology departments, the European SocieTy for Radiotherapy and Oncology (ESTRO) 10 observed a 60% reduction in the number of patients. Of these, about 14% reported a reduction above 50% of patients undergoing radiotherapy. The leading causes were reduced referrals, postponements for cases of low-risk disease, and lack of personnel.

The services that presented patients or collaborators diagnosed with COVID-19 had a similar distribution among the regions. There was a statistical difference in the number of services with infected employees and patients and the patients' origin.

among patients and employees. It is not possible to state precisely why this difference was found. One explanation is that at the time of application of the questionnaire, access to the COVID test was still challenging. Most of those services that treat predominant SUS patients integrate bigger health care facilities with broader access to those tests. There was no statistically significant association in the number of services with infected employees and the size of the service. In the ESTRO questionnaire, about 57% of the services presented employees on leave due to care for family members, transfer to other sectors of the hospital, and diagnosis of COVID-19 in 26% of these, reaching 75% in Spain and the United Kingdom.

The primary data from the questionnaire to Radiation Oncology departments during the current COVID-19 pandemic show a reduction in the number of patients in 61% of Radiation Oncology departments in Brazil. This reduction occurred without distinction in SUS and supplementary private health insurance services or related to the size of the service. About half of the services had infected patients or employees, which reduced the workforce. About a third of services interrupted treatment for patients with COVID-19, and a quarter maintained treatment at alternative times. 

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Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

Thoracic Cancers International COVID-19 Collaboration

COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registrybased, cohort study

The COVID-19 and Cancer Consortium: A Collaborative Effort to Understand the Effects of COVID-19 on Patients with Cancer

Cobertura por plano de saúde ou cartão de desconto: inquérito domiciliar na área de abrangência da Estratégia Saúde da Família

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Sociedades médicas apontam redução de 70% das cirurgias e que 50 mil brasileiros não receberam diagnóstico de câncer -SBCO. Accessed

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