Radiotherapy & Oncology during the COVID-19 pandemic

Currently we are facing with the COVID-19 pandemic one of the greatest global threats to our health, to our healthcare systems and to our societies at large. This is not because other health threats stopped to be pressing. As an example the number of preventable cancers, not least tobacco-induced cancer continues to be very substantial (according to the WHO 27% of all cancers in the WHO European Region are attributed to tobacco use). As difficult as it may be to tackle the problems of cancer prevention by tobacco control, significant improvements are within our manageable control.

This is not the case with the current pandemic spread of COVID-19 and its direct and indirect consequences for handling of other health care problems (e.g. cancer treatment). The history is fast-paced. In December 2019 a cluster of cases of severe pneumonia were reported from Wuhan, China. The disease was soon recognized to be caused by coronavirus. Since then, COVID-19 (Corona virus disease 2019), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has developed into a full blown pandemic. At the end of January 2020 the World Health Organization declared COVID-19 a Public Health Emergency of International Concern (PHEIC) [1]. The outbreak reached Europe on January 24th [2] and on March 11th the WHO declared COVID-19 as a pandemic [1]. As of April 20th the European Centre for Disease Prevention and Control reported 947 693 cases in the EU/EEA and the UK and 99 232 related deaths have occurred [3]. The number of unreported cases, at least for SARS-CoV-2 infection, is estimated to be significantly higher. Unfortunately, how much higher is currently unknown due but not limited to the fact that there is a shortage of RNA based infection tests, and a lack of validated serological tests.

COVID-19 poses an unprecedented challenge to the public health- and health care systems all over the world. In many countries a shortage of personal protective equipment, including simple surgical masks, FFP2 masks and ventilators, ICU-beds and staff, has rapidly emerged. The political, medical and public response showed enormous heterogeneity worldwide, varying considerably over time during the crisis. Not only did science react with unprecedented speed. To fight the pandemic we also rely fundamentally on the expertise from physicians and scientists from fields that are often – and as we now clearly see, wrongly – far away from the public eye.

It is obvious that cancer patients receiving radiotherapy are also impacted. In the absence of scientific evidence, the ESTRO Presidents have provided radiation oncologists with some guidance related to radiation therapy in this crisis, i.e. whether patients should delay the start of their treatment or interrupt treatment due to an infection, and on how to maintain sufficient services when staffing becomes critical. The authors emphasize that the measures taken must be seen in the context of the different phases of the COVID-19 outbreak and that the situation will differ from country to country [4].

To serve the community of our readers worldwide, Radiotherapy & Oncology, in-line with many other medical journals, has now established a rapid communication track for reports on COVID-19 in the context of radiotherapy. Our journal publishes letters, ad hoc guidelines, original papers and review papers, which will help the field of radiation oncology to deal with the crisis. To speed up dissemination, within days after acceptance COVID-19 articles will be published online as pre-proofs prior to normal online and print publication in an issue. But, most importantly the articles will be compiled in a freely accessible virtual issue on the journal homepage entitled “COVID 19 Rapid Communications”. We strongly feel that the enormous stress both on the health care system and on our health care workers mandates that scientific journals cater to the daily needs of the profession through rapid dissemination of experience gained and emerging data.

Radiotherapy & Oncology is doing its best to peer review the articles rapidly with two independent peer reviewers for research articles whenever possible and review by experienced Editors for other article types.

However, given the fast-moving nature of the crisis, readers should be aware that a fair amount of the information they read this week may be outdated or even plainly false tomorrow. Especially is it important to be aware that change of indications and treatments (such as fractionation schemes), as suggested in many of the COVID-19 Rapid Communications described below, may not be based on the years of accumulated scientific evidence normally required for such decisions. To this end, we have introduced a document heading “COVID -19 Rapid Communications” or “COVID -19 Rapid Letters” to allow the readers to easily recognize these articles and to assess them with the necessary precaution until sufficient scientific evidence has been gathered.

The Editors of the Journal, the Publisher and the European Society for Radiotherapy and Oncology (ESTRO) cannot take responsibility for the statements or opinions expressed by the authors of these articles. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.

Emergencies require unusual measures. The Editors of Radiotherapy & Oncology hope that our efforts will benefit our community for the sake and well-being of our patients. If you have important observations and contributions to the fight against COVID-19 in cancer patients that are relevant to our community, please do not hesitate to share them with us. We promise that we will look at them as thoroughly and as fast as possible.

Stay healthy…….

April 20, 2020