Table 1.

Challenges for Radiation Oncology during an outbreak of infectious disease.

Domain	Problems
Patient Groups	Cancer patients may include vulnerable individuals due to use of chemotherapy or frailty due to advanced disease These patients may be co-located with relatively fit patients receiving adjuvant therapies
Staffing	Delivery of radiotherapy requires very specific skill sets which are not generic within an acute hospital. Treatment units are therefore very vulnerable to changes in staff levels due to sickness Radiation therapists in particular have very regular close contact with a large number of patients and are at high risk of exposure
Environment	Although most radiation oncology units are have physical separation from other hospital departments there may still be a mixing of a number of patient groups in a waiting area. Some services may share waiting areas between patients on active treatment and those in follow up Treatment bunkers may contain a large amount of equipment which in cases of potential contamination may be time consuming and difficult to clean
Equipment	Treatment relies on highly specialist equipment which will usually treat high volumes of patients in sequence
Treatments	Treatment courses are delivered in fractions and efficacy is influenced by interruptions and gaps Extended treatments over many weeks are more vulnerable to interruption due to patient sickness or workforce shortage Chemoradiotherapy treatments also increase likelihood of serious infection Some treatments given for palliation or as adjuvant therapy may have altered risk benefit in the context of pandemic infections