Purpose: The COVID-19 pandemic has presented itself as a test of our abilities to adapt and evolve as cancer care facilities and as health care professionals. Understanding viral burden load earlier in the radiotherapy patients’ treatment trajectory can potential improve overall outcomes for the patient and minimize exposure to other patients and staff within the department. In response to understanding the potential burden of the disease within our department, on April 15, 2020 we began actively swabbing all symptomatic and asymptomatic patients receiving radiation therapy to better guide care. We report our experience.
Methods:
Skilling up
Due to unstable human health resources early on in the pandemic, a small team of volunteer MRT(T)s were mobilized and underwent training facilitated by the Clinical Practice Manager, Radiation and Nursing to begin a swabbing clinic within the radiotherapy department. Training included viewing a demonstration video and practical hands on session to practice their didactic learning. A medical directive was expedited to perform this controlled act. A ‘teach one, do one’ model was employed to ensure demonstration of knowledge, skill, and judgement to successfully perform nasopharyngeal swabbing. The key focus of this plan was to minimize the time spent by patients in the cancer center, the distance travelled by patients in the hospital environment and minimizing patient flow.
Screening and Swabbing
Screening and swabbing of all symptomatic and asymptomatic radiotherapy patients began April 15, 2020. Patients were initially screened upon arrival. Patients who screened positive were masked, isolated, further assessed and swabbed through nasopharyngeal testing. Treatments were deferred for all patients who had high probability of positive results. Patients who screened negative proceeded to the radiotherapy department with a procedure mask on. Upon queuing in for appointment, patients proceeded to an examination rooms where a small team of trained Radiation Therapists completed an assessment and documentation of any typical and atypical symptoms. After explaining the procedure, a nasopharyngeal swab was completed. Information regarding self-isolation during COVID-19 was provided then patients proceeded to treatment. Results were available and reported 48 hours later. Reswabbing was triggered if patients reported new or worsening symptoms (both typical and atypical).
Results: The six month long swabbing process resulted in a coherent person-centered care. Consequently, the radiation therapy department was able to identify and take appropriate isolation and infection control measures during CT Sim and treatment delivery of those COVID-19 positive patients to effectively minimize COVID-19 spread.
Conclusions: From April 15, 2020 to May 5, 2020, we swabbed a total of 101 radiotherapy patients, 49 males, 52 females. Median age was 67 years old (range 22 – 90 years old). The majority of patients were undergoing a radical course of radiation treatment (85%), 15% were undergoing palliative course of treatment. Of the total patients swabbed, 16 were symptomatic, 85 were asymptomatic. Initial swabbing results of the symptomatic patients swabbed; 15 patients’ negative, 1 patient indeterminate. Reswab was performed and the outcome was negative. All asymptomatic patients swabbed reported negative results. During this reporting period six previously asymptomatic patients reported symptoms (either typical or atypical) resulting in a reswab. All reswabs were negative. Our radiation treatment program were early adopters of testing all symptomatic and aysymptomatic radiotherapy patients on active treatment in an effort to understand burden within our radiation therapy patient population and to implement plans to safely deliver care while protecting our staff and patients.