key: cord-1026730-hdwd9mg1
authors: Zhen, Hongnan; Zhang, Fuquan; Guan, Hui; Liu, Zhikai; Shen, Jie; Hou, Xiaorong; lian, Xin; Hu, Ke
title: COVID-19 outbreak and cancer patient management: viewpoint from radio-oncologists
date: 2020-05-08
journal: Radiother Oncol
DOI: 10.1016/j.radonc.2020.04.025
sha: 52f29fb86b3e7e71152fe3829f2ae5a7345a4b97
doc_id: 1026730
cord_uid: hdwd9mg1

nan

COVID-19 has emerged as a major global health threat since December, 2019. By April 1st, 2020, there were more than 800,000 patients with confirmed COVID-19 infection worldwide.Radiotherapy is continuous in treatment schedule. Interruption of the treatment or delay of the treatment may jeopardise therapeutic efficacy.Liang et al. [1] demonstrated that due to receipt of immunotherapy, cancer patients are at higher risk to be infected with COVID-19. Recently, Xie [2] et al. revealed cancer patients older than 60 years old have an excess risk of COVID-19 infection, which deserves special attention. Filippi et al [3] pointed out that as a cancer-specific treatment, radiotherapy must be applied to patients with indications.Achard et al [4] proposed that shortening treatment course can provide the essential treatment of cancer patients, reduce the possibility of COVID-19 exposure and lower the risk of COVID-19 infection at the same time.

We developed a questionnaire to learned about the physicial and metal situation of patients undergoing radiotherapy.Overall, 101 questionnaires were obtained.Detailed information is presented in Table 1 .Our center puts forward the following suggestions regarding treatment of patients with indication for radiotherapy. Ethical approval of the current study was obtained from the local ethics committee.

Acute radiotherapy pneumonia should be differentiated from COVID-19 pneumonia. According to the "Guidance for Corona Virus Disease 2019: Prevention, Control, Diagnosis and Management (7th Edition)",radiotherapy should be suspended or postponed among patients with fever.At the result of nucleic acid detection confirmed or suspected of COVID-19 infection, the patient will be transferred to the designated COVID-19 hospital for treatment.

For patients with alternative therapy,radiotherapy is not recommended for the time being.Informing patients of the advantages and disadvantages of the radiotherapy, could help patients learn about the decision of the radio-onlogists. For patients indicated for adjuvant radiotherapy,postponing the start of radiotherapy until the epidemic is stable or even after the end of the epidemic is a reasonable choice. For patients indicated for neoadjuvant radiotherapy, appropriate extension of the course of oral chemotherapy can be an alternative approach.For individuals with emergent radiotherapy indications, radiotherapy should be intervened immediately.

Treatment segmentation and dose could be adjusted by two or more experienced radio-oncologists. Stereotactic radiotherapy and shortening the course of treatment could also be considered based on evaluation of patient COVID-19 exposure risk.

For patients with stable disease, the follow-up period should be more adjustable. For example, within the first two years after radiotherapy completion, the follow-up could be every 3-6 months.It is reasonable to postpone their next follow-up after the control of COVID-19 pandemic.

With the help of tools like Wechat and network video phone, online multi-disciplinary treatment can be held to discuss the most optimal treatment plan for the patient, not only reduce the gathering but also decrease the possibility of COVID-19 infection.

Online health education and counseling could be performed regarding treatment principles, psychological counseling, nursing guidance and so on to lower the risk of anxiety and depression in cancer patients. 

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. The Lancet Oncology

Risk of COVID-19 for patients with cancer. The Lancet Oncology

Covid-19 Outbreak in Northern Italy: First Practical Indications for Radiotherapy Departments

Radiotherapy in the time of the Coronavirus pandemic: when less is better

Acknowledgement:We thank the patients and their families and the participating study teams

Yuan Tian and Xiaoyin Bai for insightful suggestions;and Shiyu,Jiang for writing assistant