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, Xia et al. [2] 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 physical 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.
Table 1.
Characteristics of the patients with cancer patient undergoing radiotherapy.
| Characteristics | No. of patients, n (%) |
|---|---|
| Gender, n (%) | |
| Male | 17 (16.8%) |
| Female | 84 (83.2%) |
| Age, median, year (range) | 49.6 (12–83) |
| Recidence, n (%) | |
| Local | 51 (50.5%) |
| Non-local | 50 (49.5%) |
| Education level, n (%) | |
| Bachelor degree or above | 49 (48.5%) |
| Secondary schools | 44 (43.6%) |
| Primary school and below | 8 (7.9%) |
| Habitat, n (%) | |
| Urban | 90 (89.1%) |
| Rural | 11 (10.9%) |
| Diagnosis, n (%) | |
| Breast cancer | 40 (39.6%) |
| Cervical cancer | 33 (32.7%) |
| Endometrial cancer | 5 (5%) |
| Prostate cancer | 4 (3.9%) |
| Others | 19 (18.8%) |
| Disease stage, n (%) | |
| I | 29 (28.7%) |
| II | 30 (29.7%) |
| III | 30 (29.7%) |
| IV | 11 (10.9%) |
| Cannot be staged | 1 (1%) |
| Current state, n (%) | |
| After radiotherapy | 13 (12.9%) |
| During radiotherapy | 82 (81.2%) |
| Has not start radiotherapy | 6 (5.9%) |
| Cardinal symptoms at present, n (%) | |
| There was no obvious discomfort | 35 (34.7%) |
| Lack of strength | 18 (17.8%) |
| Pain | 9 (8.9%) |
| Insomnia | 8 (7.9%) |
| Diarrhea | 4 (4%) |
| Bleeding | 1 (1%) |
| Weight loss | 1 (1%) |
| Others | 25 (24.8%) |
| How to see a doctor | |
| Wechat consultation | 41 (39.8%) |
| Non-pneumonia designated hospital | 25 (24.7%) |
| Telephone consultation | 23 (22.3%) |
| Internet online consultation | 18 (17.5%) |
| Go to the drugstore | 4 (4%) |
| Expert webcast | 3 (3%) |
| Other | 25 (24.3%) |
Differential diagnosis
Acute radiotherapy pneumonia should be differentiated from COVID-19 pneumonia. According to the “Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7)”, 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.
Make individualized radiotherapy plan
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-oncologists. 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.
Optimize the treatment mode
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.
Follow-up schedule
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.
Diagnosis and treatment mode
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.
Psychological counseling
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.
CRediT authorship contribution statement
Hongnan Zhen: Writing - review & editing. Fuquan Zhang: Supervision. Hui Guan: Writing - review & editing. Zhikai Liu: Writing - review & editing. Jie Shen: Data curation. Xiaorong Hou: Data curation. Xin lian: Data curation. Ke Hu: Supervision.
Acknowledgements
We thank the patients and their families and the participating study teams (Junfang Yan, Jing Shen, Qingyu Meng, Wenhui Wang, Jiabin Ma and Shuai Sun) for making the study possible; Yuan Tian and Xiaoyin Bai for insightful suggestions; and Shiyu Jiang for writing assistant.
Footnotes
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. For more information see the editorial “Radiotherapy & Oncology during the COVID-19 pandemic”, Vol. 146, 2020.
References
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