Table 2.

Physician Descriptions of Specific Processes or Solutions That their Hospital Is Implementing to Help Deliver Oncology Care Safely

Category	Processes Reported as Implemented
Social distancing in clinical areas	Reduce the number of patients per d and per clinic area Social distancing in waiting rooms, decreasing/staggering appointments Delayed appointments for off‐treatment patients Increased space between recliners in daycare and waiting area Physical isolation for all children with cancer undergoing treatment Limit access to pediatric wards to 1 parent only Visiting restrictions (only 1 person can be with a patient) Not allowing change of caregiver while in hospital No external food or product allowed to inpatient unit Closed the playroom/entertainment area
Screening measures	Phone/virtual clinic screening for all patients before inpatient or outpatient appointments Checking temperature of staff and clinic patients at hospital entrance—PCR testing for COVID‐19 (rapid tests)
Use of PPE	Require face mask use by patient, family member, and hospital staff Full PPE for all health care professionals
Special precautions	New separate isolation unit was allocated for patients with respiratory symptoms COVID‐19 PCR testing for all suspected cases New patients are admitted to an isolated unit for 14 d, then they can be transferred to the unit
Other hygienic interventions	The surfaces at the cancer center are periodically disinfected The reception workers wear special uniforms Serial COVID‐19 awareness sessions on hand hygiene practices and use of PPEs for health care workers Staff practicing proper hand hygiene Patient education sessions regarding hand hygiene and social distancing
Staffing	Nurses shifted to a 24‐h work schedule Decreasing staffing to essential only Providing opportunity for staff to work from home Splitting of staff into 2 teams on weekly basis to reduce potential exposure
Administrative processes	Daily virtual huddle with all stakeholders Faster administrative process for admitting patients; admission is done immediately, similar to emergency cases
Treatment modifications	Avoiding very myelosuppressive chemotherapy regimens Modification of chemotherapy protocol cycles when possible Hypofractionation of radiation therapy when possible Delaying of autologous BMT Delaying of allogenic BMT when possible Prioritizing surgical procedures Cancel monthly injections of the maintenance treatment of ALL so that patients can be treated at home with oral 6‐MP and MTX, and perform monthly CBC sent to their physician by social media communication Decrease inpatient admissions by modifications to treatment plans
Medications	Medication delivery to patient home Review of medication stock Group patients with same treatment to optimize medication supply Personally buying medications when necessary Deliver 6‐MP/MTX through courier services because of transport restrictions
Blood products	Call for blood donors and volunteers from hospital staff Patient‐directed blood product donation at the time of admission
Communication	Use of virtual clinics, online clinics, and teleclinics Implemented online follow‐up for all patients, available 24/7 Giving patients staff phone numbers to answer needed inquiries All on‐treatment patients were tracked, and those who missed appointments were called by phone to decrease abandonment Use of teleclinics for follow up of patients with ALL on maintenance therapy Visits to hospital were minimized through the use of social media to review laboratory results and through a dedicated helpline for minor problems
Transportation and housing	Staff has its own transportation option (special buses) to avoid using public transport and limit the potential transmission Transportation for nurses is secured by hospital Permission papers to allow patients to attend hospital on visit date Using ambulance services for physicians/patients to travel to the hospital Hotline to facilitate travel of the patient to the hospital Home health visits for pharmacy and laboratory tests Use “parent housing” at a close‐by hotel to avoid travel issues
Collaboration among hospitals and clinics	Treating patients with cancer who are stranded from other hospitals because of the lockdown Deliver satellite services in other cities with the help of local hospitals; send patients who need supportive care to the hospital nearest their home with treatment plan and letter to the physician
Multidisciplinary care	All tumor boards are ongoing using online/virtual meeting facilities
Teaching and research	All teaching activities are continuing using online/virtual facilities

Abbreviations: 6‐MP, mercaptopurine; ALL, acute lymphoblastic leukemia; BMT, bone marrow transplantation; CBC, complete blood count; COVID‐19, coronavirus disease 2019; MTX, methotrexate; PCR, polymerase chain reaction; PPE, personal protective equipment.