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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 846-847

Can a pandemic put a spanner in the radiotherapy workflow process?

Department of Radiation Oncology, Ramaiah Medical College, Bengaluru, Karnataka, India

Date of Submission01-Oct-2020
Date of Decision08-Oct-2020
Date of Acceptance08-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Janaki Gururajachar Manur
Prof, Department of Radiation Oncolgy, MSRMC, Bangalore
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_305_20

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How to cite this article:
Agrahara Srinivas KK, Alva RC, Manur JG. Can a pandemic put a spanner in the radiotherapy workflow process?. Cancer Res Stat Treat 2020;3:846-7

How to cite this URL:
Agrahara Srinivas KK, Alva RC, Manur JG. Can a pandemic put a spanner in the radiotherapy workflow process?. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 18];3:846-7. Available from: https://www.crstonline.com/text.asp?2020/3/4/846/304978

Chauhan et al., in their single-institutional study conducted during the coronavirus disease 2019 (COVID-19) pandemic, have systematically looked into the effects of the nationwide lockdown on the radiation treatment of patients with cancer in their hospital.[1] We would like to share our similar observations.

We observed that because of the travel restrictions during the lockdown, the patients could not receive timely treatment. Upon restaging, it was observed that in several cases, the disease had progressed to a higher stage and hence palliation was considered. The disease had not progressed in all patients; nevertheless, restaging was essential.

The authors could have studied the patients' characteristics to assess if there was any significant difference between the different tumor sites. Another important point would be to see if there was any longer time between the decision to treat and the actual starting of radiation. We observed a more pronounced difference for brachytherapy procedures as it required a prior reverse transcription-polymerase chain reaction (RT-PCR) to be performed. It would also be interesting to see whether the brachytherapy practice changed from multiple sessions to a single session.

The authors observed that the number of patients who defaulted after treatment planning increased during the second lockdown phase by more than double. Our observation was slightly different; the patients either did not turn up for treatment, but when they did, they mostly completed the planned radiation.

As far as compliance to treatment goes, we had patients with interrupted radiation, but interestingly, we also had many more patients who were worried about cancer progression and hence were willing to take all precautions throughout radiation. We also had a couple of patients who did not want to expose their attendants to COVID-19 during travel and admissions, and therefore wanted to postpone cancer therapy. With our hospital being designated as a COVID-19 care center, some patients refused to even enter the hospital premises for fear of getting infected, as seen with a few other hospitals.[2]

With the relaxation of lockdown restrictions and considering the likelihood of the pandemic continuing for a longer time, cancer care is slowly coming back to normal. However, issues related to testing for COVID-19 during radiation persist.[3] Different centers practice varying schedules, but overall, the cost of repeated testing, especially for those under government schemes, is high. However, we are helpless as repeated testing is mandatory.

Patients were willing to start and continue radiation, but were reluctant to receive concurrent chemotherapy, probably because of the logistic issues such as repeated blood tests, admissions, and toxicities apart from the financial burden. Similarly, the medical oncologists were reluctant as administering concurrent chemotherapy on a weekly basis would require extra effort.

A major challenge for us was the follow-up of patients, especially of those with head-and-neck cancer who hailed from non-metropolitan . The patients receiving radiation therapy would show sequelae similar to the symptoms of COVID-19, and the local facilities would not be available.[4],[5] In such situations, the patients were provided telephonic consultation and were asked to visit the hospital only when necessary.

With the COVID-19 mortality rates dropping and the recovery rates improving, the challenges in the near future would be the post-COVID-19 residual side effects such as severe neurotoxicity, myocarditis, and pneumonitis[6] and their implications on the sequelae of radiation, long-term tumor control, and survival. Post-COVID-19 rehabilitation clinics, such as the one started at our center, will go a long way to restore the patients' overall wellbeing.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Chauhan R, Trivedi V, Rani R, Singh U, Singh V, Shubham S, et al. The impact of COVID-19 pandemic on the practice of radiotherapy: A retrospective single-institution study. Cancer Res Stat Treat 2020;3:467-74.  Back to cited text no. 1
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Khetrapal S, Bhatia R. Impact of COVID-19 pandemic on health system and sustainable development goal 3. Indian J Med Res 2020;151:395-9.  Back to cited text no. 2
[PUBMED]  [Full text]  
Munshi A, Rastogi K. Management of cancer during the COVID-19 pandemic: Practical suggestions for the radiation oncology departments. Cancer Res Stat Treat 2020;3:115-8.  Back to cited text no. 3
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Patil V, Noronha V, Chaturvedi P, Talapatra K, Joshi A, Menon N, et al. COVID-19 and head and neck cancer treatment. Cancer Res Stat Treat 2020;3:15-28.  Back to cited text no. 4
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Sinha S, Laskar SG, Mummudi N, Budrukkar A, Swain M, Agarwal JP. Head-and-neck cancer radiotherapy recommendations during the COVID-19 pandemic: Adaptations from the Indian subcontinent. Cancer Res Stat Treat 2020;3:424-6.  Back to cited text no. 5
  [Full text]  
Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;26:1017-32.  Back to cited text no. 6


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