TABLE 1.

Triage system during COVID‐19 pandemic

Zones and risk	Patient category	Plan
Green Very low risk	Patients who completed treatment recently Awaiting end treatment assessment/review of reports Long‐term survivors	Patients were asked to stay at home. The focus was on adhering to hand/respiratory hygiene and social distancing Teleconsultation was continued
Blue Low risk	Patients on follow up and not on intensive chemotherapy cycles like ALL maintenance, RB intraocular disease/HL/LCH/RMS mid‐treatment showing good response	No need to travel from home town to Delhi ALL patients may continue maintenance and send CBC/LFT via email Chemotherapy including ITM may be given ata nearby hospital equipped to give chemotherapy after contacting primary treating team Chemotherapy for RB/HL/LCH/RMS may be given as prescribed. If not possible, it may be delayed by a few (2‐3) weeks CML patients must continue taking imatinib
Orange Intermediate risk	Patients requiring surgery/radiation/HSCT Interdepartmental consultation (multimodal management)	Deferred as elective surgery/radiation had been postponed Support staff and facility of admission affected hence transplants also postponed Patients switched to alternative/oral metronomic chemotherapy to bridge the gap Done by telephonewith respective departments with limitations
Red High risk	Delay in chemotherapy is likely to affect outcome (usually high‐dose chemotherapy) Leukemia (induction/consolidation/interim maintenance) Non‐Hodgkin lymphoma Initial cycles of solid tumors (Ewing sarcoma, RMS, hepatoblastoma, germ cell tumor)	Chemotherapy was administered via inhouse admission/day care facility
Yellow Risk not applicable	Patients with poor outcome (relapsed and progressive disease on chemotherapy, metastatic tumors with poor survival outcomes)	Counseling with advice on palliation was given and metronomic chemotherapy used wherever applicable

Zones and risk

Patient category

Plan

Green

Very low risk

Patients who completed treatment recently

Awaiting end treatment assessment/review of reports

Long‐term survivors

Patients were asked to stay at home. The focus was on adhering to hand/respiratory hygiene and social distancing

Teleconsultation was continued

Blue

Low risk

Patients on follow up and not on intensive chemotherapy cycles like ALL maintenance, RB intraocular disease/HL/LCH/RMS mid‐treatment showing good response

No need to travel from home town to Delhi

ALL patients may continue maintenance and send CBC/LFT via email

Chemotherapy including ITM may be given ata nearby hospital equipped to give chemotherapy after contacting primary treating team

Chemotherapy for RB/HL/LCH/RMS may be given as prescribed. If not possible, it may be delayed by a few (2‐3) weeks

CML patients must continue taking imatinib

Orange

Intermediate risk

Patients requiring surgery/radiation/HSCT

Interdepartmental consultation (multimodal management)

Deferred as elective surgery/radiation had been postponed

Support staff and facility of admission affected hence transplants also postponed

Patients switched to alternative/oral metronomic chemotherapy to bridge the gap

Done by telephonewith respective departments with limitations

Red

High risk

Delay in chemotherapy is likely to affect outcome (usually high‐dose chemotherapy)

Leukemia (induction/consolidation/interim maintenance)

Non‐Hodgkin lymphoma

Initial cycles of solid tumors (Ewing sarcoma, RMS, hepatoblastoma, germ cell tumor)

Chemotherapy was administered via inhouse admission/day care facility

Yellow

Risk not applicable

Patients with poor outcome (relapsed and progressive disease on chemotherapy, metastatic tumors with poor survival outcomes)

Counseling with advice on palliation was given and metronomic chemotherapy used wherever applicable

Abbreviations: ALL, acute lymphoblastic leukemia; CBC, complete blood count; CML, chronic myeloid leukemia; EUA, examination under anesthesia; HSCT, hematopoietic stem cell transplant; ITM, intrathecal methotrexate; LCH, Langerhans cell histiocytosis; LFT, liver function test; RB, retinoblastoma; RMS, rhabdomyosarcoma.