. 2021 Feb 26;28:1073274821997425. doi: 10.1177/1073274821997425

Table 4.

Summary of Included Articles.

Author	Study Type	Country	Key Adaptations/Intervention service delivery Outcome (in Italic)
Agyapong et al⁵²	Report	Canada	Trailed providing self-subscribed supportive message to reduce anxiety and depression in cancer patients
Ardizzone et al⁷⁵	Report	USA	Only cancer patients that were not able to wait 2-3 months without a detrimental effect on their health received surgery If a comparable non-surgical option was available, then this was conducted instead of surgery
Baabdullah et al⁶⁷	Survey	Saudi Arabia	Adopted telephone consultations in Oncology Departments with patients being able to access patient-accessible electronic records Outcome: Survey reveals that transition to telemedicine is well accepted by cancer patients
Batt et al⁷⁶	Prospective cohort study	UK	Treatment adaptation—switched to local anesthesia from general anesthesia in selected patients with breast cancer.
Blot et al⁷⁷	Article	France	Highlighted role of ethical committee board during COVID-19 Offered reflective support to physicians facing difficult dilemmas. Assisted decision making through ethical monitoring, promoted the supportive and palliative dimension of care in a holistic approach
Brody et al³⁸	Cross-sectional (Multi-center survey)	USA & Canada (North America)	Surgeons had to triage which patients should be operated on urgently vs those which could be delayed indefinitely Surgeons were willing to change their standard practice and recommend radiotherapy instead of surgery Most surgeons were not willing to delay treatment beyond 4-6 weeks (Due to known risk of mortality/morbidity resulting from treatment delays)
Butler et al¹⁹	Article	UK	COVID-19 protected hospital focused on cancer services. 2-weekly internal scheduling meeting was held to ensure efficient and safe patient scheduling for surgery A designated form was created to document all change/deferment in treatment, due to the COVID-19 pandemic Limited number of personnel allowed to attend MDT meetings physically with other members of the team joining via teleconferencing MDT outcome communicated to patients via teleconferencing and patients would be advised to self-isolate for 14 days at the earliest if the MDT outcome was to offer surgical treatments Streamlined peri-operative assessment to reduce patient’s travel to hospitals. COVID-19 swab test pre-surgery and CT chest surveillance for patients receiving category 2-3 surgeries Patients were provided information on increased risk from COVID-19 infection when being consented for surgery Full PPE was worn by staff intra-operatively Intubation involved only a limited number of anesthetic team Surgical staff were instructed to be screened for temperature and change clean scrubs after entering hospital
Casella et al¹¹	Editorial	Italy	Rearranged space to reconfigure workflow in radiology departments Multidisciplinary meetings replaced by teleconferencing Outpatient appointment partially taken over by telecare Telematic consultations with psycho-oncology specialists for patients with high-grade psychological distress Protection: widely distributed alcohol-based hand gel Reduction of surgical lists from 4 days to 2 days per week Staff segregation: 3 teams of physicians who were not in contact with each other Implemented Patient triaging and body temperature surveillance at hospital entrance Treatment adaptation: Adjusted the indications to access neoadjuvant therapy
Chiang et al¹⁴	Article	Singapore	Screening clinics to triage patients Swab-and-Send-Home (SASH) program for suspected cases of COVID-19 or vulnerable patients at increased risk. E.g. Cancer patients undergoing chemotherapy with COVID-19 symptoms 1 accompanied visitor was allowed for outpatients Deferred non-urgent appointments and scans New patients with suspected cancer will receive biopsy or imaging on the same day as their clinic appointment if possible Capped number of patients per session Electronic billing and prescription Home delivery of medications Dedicated ward was established for cancer patients with COVID-19 Centralized coordination of surgical volume to ensure sufficient ITU beds is available Pre-op questionnaire to triage patients for risk of contracting COVID-19 Enhanced surgical recovery program to reduce hospital stay post-operation Full PPE required for surgical procedures that are aerosol generating, surgical masks with eye shield for other lower risk procedures Delayed non-urgent or surveillance imaging to improve turnaround time for urgent investigations
Cinelli et al⁵³	Letter	Italy	Used teleoncology to monitor skin toxicity from cancer treatment via telephones or email Department set up a specific outpatient clinic dedicated to dealing with chemo-, immune-, and radiotherapy-related cutaneous and mucosal adverse events.
Civantos et al⁹	Report	USA	An otolaryngologic triage committee was set up to correctly allocate resources to patients Patients with tumors were screened for non-surgical choices of treatment Patients were tested twice for COVID-19 before operation. Questions regarding triage needing multidisciplinary action were asked virtually to a Head and Neck Tumour Board Patients going through chemotherapy and radiation were tested for COVID-19 before starting the treatment
Civantos et al⁴⁹	Report	USA	Cordectomy was carried out using a sharp technique, replacing a laser to lessen aerosolization Surgical interventions were delayed, especially in immunocompromised patients Telemedicine communication between patients and doctors was enforced PPE was mandatory for surgery
Collins et al¹⁷	Editorial	USA	Urology department in USA: Segregation of staff: 2 teams of staff taking alternating between emergency operations and outpatient activities weekly Testing for patients with symptoms and patients who were due to receive surgical treatments Outpatient appointments conducted by telephone calls Outsourced urgent elective cases to non-COVID private hospitals temporarily. Surgeries to be performed by the same consultant. Where possible, emergency surgeries were delayed until COVID test was negative. Limited attendance to MDT meetings with additional participants joining via teleconferencing Outcome: 5 out of 101 inpatients at COVID hospitals contracted COVID-19. No outsourced patients were infected Decreased outpatient referrals with 66% decrease in new cancer diagnosis Telemedicine led to reduced costs and savings
Curigliano et al⁵⁵	Opinions	Italy	Gave periodic updates on infected cases, adjusted level of risk alerts Mandatory provision of PPE to healthcare workers Patient education: used phone calls or social media messages to deliver key advice in prevention of COVID-19 Treatment adaptation: Cancer designated hubs were put in place to deliver necessary curative treatments in Lombardy region Patients on oral treatments were monitored remotely and higher volume of drug supply was provided to patients at each hospital visit Blood monitoring was performed at local labs
Czernin et al³⁶	Report	International	All patients on hospital sites had temperatures recorded and positive patients were told to isolate Patients were screened upon arriving at hospital where they filled out a questionnaire on symptoms and their body temperature was taken. Oncology staff were put into 2 separate teams, switching between working from home and in the clinics Telehealth consultations instated Virtual MDT meetings Screening spots were outside hospitals with people who have respiratory symptoms.
de Marinis et al³⁹	Retrospective	Italy	Patients received emails with recommendations to follow for protection from COVID-19 as well as telephone triage to check for symptoms and personal contacts with people suspected to have COVID-19 Patients were screened by telephone triage on day 1 of each clinical visit for symptoms Day of visit/treatment: clinical triage was done at the cancer center upon admission (fever and respiratory tract check) Patients with symptoms 19 underwent nasal swab testing. Access to the premises was forbidden to all people except patients and staff Patient evaluation of the risk/benefit ratio for delaying anticancer treatment was undertaken Visits/treatment were delayed for patients with recent respiratory symptoms Deliveries of oral cancer treatments were made to pharmacies near the patient’s home. Follow up visits were replaced with email, phone calls, telematics evaluation of CT scan imaging. Telemedicine evaluation was adopted. Treatment for progressive tumors was not delayed. (neo)adjuvant therapies, chemo-radiotherapy, first line therapies for metastatic disease, chemotherapy for high grade tumors, and clinical trial treatments were continued. Referrals to cancer centers closer to patients’ homes were considered. Outcome: In 5 weeks of multilevel measure—only 6/325 of patients evaluated in the study with lung cancer tested positive for COVID-19 and only 1 patient required oxygen support due to severe COVID-19. No deaths occurred
Dharmarajan et al⁵¹	Cross-sectional (survey)	USA	A multidisciplinary team of specialists used a virtual multidisciplinary conferencing (MDC) approach which was accessible at all locations in order to streamline head and neck oncologic care for patients for timely diagnosis and organisation of treatment plans Outcomes: Use of virtual MDC improved referral coordination, decreased delay in diagnosis and treatment, had a higher frequency of MDT evaluation and reduced patients and provider travel burden. Challenges in implementing the MDC: reliable technical setup, increased length of virtual case presentations, delays in receiving supporting information such as imaging and pathology slides and cost of virtual informatics infrastructure. It appeared that virtual MDC participants had positive experiences and found it compatible to in-person meetings
Elkaddoum et al⁵⁹	Article	Lebanon	MDT meetings were carried out virtually using Microsoft Teams Outcomes Virtual MDT appears to be able to accommodate more participants than face-to-face meetings Having patient data gathered on a single electronic system was an advantage to ensure efficiency of virtual meetings
Elkin et al³¹	Review	USA	A telephone triage was developed by Oncology nurse educators to screen incoming patients for symptoms and potential exposure to COVID-19 The triage system was incorporated into electronic health record documentation and easier identification of high-risk patients in clinical settings with appropriate prognostic algorithms
Flannigan et al⁵⁷	Editorial	Canada	Clinic appointments were done virtually Patient education sessions were given on exercising, nutritional and psychological support. Extra attention was given to identity those who demonstrate signs of depression from isolation Intracavernosal injection therapies were suspended
Fosker²⁶	Editorial	Bermuda	The outpatient department and chemotherapy suite were relocated to free up physical space Treatment time was lengthened in order to allow more time for safety checks During treatment reviews, clinicians picked up individual patients from the car park
Frey et al⁶⁶	Prospective cohort study	USA	Ovarian cancer survivors were experiencing delays in cancer-directed treatment during the COVID-19 crisis and reported high levels of cancer worry, anxiety, and depression
Giuliani et al⁵⁸	Editorial	Canada	Quick transition to telemedicine was made since the beginning of the pandemic to reduce in-person care Gave Digital Information Prescription: Online classes, easy access to database of health information Developed core online education systems by multidisciplinary team Designated search engine is created to help patients locate reliable cancer-related patient education materials Online multimedia classes about cancer were provided to patients and families
Gupta et al⁴⁸	Cohort study/report	India	11 cancer institutions stopped all elective surgeries and outpatient clinics—only urgent cases were admitted and only crucial surgeries were performed 5 institutes still provided Head and Neck Cancer treatments 4 cancer centers still performed all types of surgeries, even with limited access to PPE Many centers liaised with patients via telephone consultations or in clinic
Grenda et al⁵⁴	Article	USA	New patient evaluation shifted to telemedicine In lung cancer clinics, patients requiring multidisciplinary intervention saw different members of the MDT team in a single visit Telemedicine used in triaging post-operative patients with acute issues and subsequent follow up scheduled at 48 hours postoperatively
Guven et al¹²	Short Report	Turkey	Floors were marked for enforcement of social distancing while in hospital Follow up appointments were performed over telephone Patient triaging with temperature measurements was done at hospital entrance Only 1 companion allowed per patient Patients were informed to go to palliative care outpatient, rather than emergency department, for treatment-related symptoms All new patients were given same day appointments to avoid delay in diagnosis
Harky et al.⁶¹	Letter	UK	Telemedicine has been widely adopted into current practice Out-of-hours operations have been a viable coping strategy adopted Patients triaged on respiratory symptoms and contact histories
Indini et al³³	Cross-sectional (multi-center survey)	Italy	COVID-19 diffusion containment measures: Triage of patients (vital sign monitoring at entrance of hospital) Patients questioned on symptoms during 15 days before visit and possible contacts with COVID-19) Triage procedures sometimes resulted in preventative isolation and diagnostic work up of symptomatic patients (nasal swab/ chest x-ray) Non-urgent visits delayed (mainly follow up visits) MDT video conferencing for meetings Patients underwent telephone interviews/counseling Access to oncological hubs was limited/denied for visitors/caregivers (outpatient visits, day hospital and ward admissions Family doctors delegated to conduct follow-ups/carry out home visits Telephone line was set up for emergencies Diffusion of COVID-19 in oncology units: One third of oncological hubs had to employ their oncologists for guard duties in the internal medicine ward/emergency dept. Patients’ treatments were redistributed homogeneously throughout the week Doctors on COVID wards waived from oncologic activities to reduce the risk of infection. Outcomes: Twenty-four percent of Italian oncology departments had at least 1 patient diagnosed with COVID-19. 23% of patients accessed the emergency room with symptoms, 18% diagnosed after triage procedure and/or a medical interview regarding possible contacts with COVID-19
Jiang et al⁶⁰	Review	USA	Remote care was established to facilitate anti-cancer medication deliveries 92.8% reported very satisfied with the experience with using clinical video telehealth (CVT)
Lee et al¹⁵	Perspective	Hong Kong	Routine clinic appointments were postponed (only urgent conditions to be seen or reschedules Number of doctors seeing consultations was reduced performing aerosol generating procedures. Reduction of caseload (doctor saw only 10-15 patients per session) allowing time needed for infection control compliance All doctors were given PPE Drug refill clinic was set up to allow stable patients to get repeat prescription without consultation Extra clinic sessions on weekends and evenings were considered to deal with accumulation of rescheduled appointments Telemedicine appointments were implemented (took 10 minutes longer than face-to-face appointment) Preoperative personnel for procedures was kept to a minimum . Video laryngoscopes with a plastic drape to form a barrier between them and the patient’s airway to decrease aerosol spread were used by Anaesthetists Only experienced surgeons were selected for airway operations in order to reduce contact time and risk. Reduction of operation theater service (only emergency and priority elective operations go ahead)
Lee et al⁴⁷	Editorial	Korea	Aggressive contact tracing and quarantining of COVID-19 positive patients and any personnel in close contact Patient triaging by telephones a day before appointments were done COVID-19 testing was offered to patients attending chemotherapy infusion
Lee et al²⁷	Prospective cohort study	UK	Patient segregation: hospital visits were minimized by favoring replacement of intravenous agent with oral agents Staff segregation: COVID-19 negative and COVID-19 positive dedicated teams were formed Outcomes: Retrospective data shows no increase in mortality from COVID-19 after chemotherapy, suggesting that curative treatments, such as chemotherapy or ITU admission should not be delayed in cancer patients.
Lobascio et al⁵⁶	Opinion	Italy	Patient education: Upon patient discharge, patient information leaflet on nutritional advice during COVID-19 was delivered to patients Nutritional follow-up was done by telephone consultations Monitoring and management of patient’s nutritional status was completed remotely by using mobile phone apps
Lombe et al⁶⁸	Article	Zambia	Staff training was provided to improve understanding of the disease and key preventative measures. Emphasis was placed on how to respond if faced with patients undergoing treatment who were COVID-19 positive. Outpatients were screened for symptoms and temperatures. High risk patients were transferred to an isolation room for further review Visitation of inpatients was suspended Testing of all inpatients was made mandatory Tiered PPE protocol was implemented depending on patient type Mental health team was involved in supporting medical staff via both grouped and individual care interventions. Staff were encouraged to report any concerns
Mei et al²¹	Reportage	China	Patients and healthcare workers in the hospitals were screened (via nucleic acid and antibody tests in combination with CT scans) An isolation ward was created with an increased prevention level compared to the rest of the hospital Telemedicine was used to follow up on discharged patients and medicine was mailed to patients Confirmed patients were isolated and visits were prohibited Wearing of masks and hand sanitization by staff and patients were made mandatory To combat shortage of staff, 50 doctors and nurses were redeployed and temporarily relocated from other not-in-service departments to oncology departments (which also consisted of specialists in serious infections and management of respiratory tract diseases COVID-19 confirmed and suspected cases were redirected to other hospitals Careful evaluation of cancer patients was undertaken before admission with an emergency department for serious care Elective patient admissions were postponed Chemotherapy-free alternatives were given when possible. Chemotherapy protocol was adjusted/postponed Free-of charge online fever clinic was set up
Mendoza et al²³	Editorial	Philippines	Pre-scheduling and pre-screening of all patients was done for outpatient consultations and admissions Referrals were coordinated to local oncologists for patients with travel restrictions Patients receiving systemic cancer treatment were prioritized The outpatient clinic was restructured physically and procedurally hand hygiene and social distancing was observed in hospital Personnel working in COVID-19 areas were segregated Medical supplies were secured by working with non-governmental organizations Centralized inventory system for medical consumables was made
Millar et al⁶⁵	Survey	UK	Psycho-oncology service was transitioned to remote care with regular “check-ins” arranged on an individual basis Outcome: Some cancer patients report concerns over limitations of remote care on the widened physical distance between therapists and patients, lack of opportunity to reflect during the travel and that resources on remote care might not be utilized to fulfil cancer-related goals
Mirnezami et al⁷³	Letter	UK	Treatment adaptation: short term radiotherapy was favored for locally advanced colorectal cancer rather than long term radiotherapy
Morrison et al⁶⁹	Article	USA	Elective cases were postponed. Each scheduled case was approved by the Department Chair. Surgery was only performed after negative COVID testing and sufficient PPE is available Tiered PPE protocol according to case type was implemented to conserve PPE N95 respirator was reprocessed with UV light for repeated use Clinic availability was limited to patients with a new diagnosis, worsening symptoms and post-operative follow-up. Residents were protected from COVID-status unknown patients Guest visits to hospitals were limited
Moss et al³²	Prospective cohort studies	UK	Routine testing of patients was done prior to admission to hospital
Mulvey et al⁶²	Opinions	USA	Almost 2/3 of follow-up cancer care was conducted virtually Difficult conversations usually reserved for in-person visit were shifted to video or phone consultations. Low-risk drugs that require subcutaneous or intramuscular administration were safely administered at home. Fixed-dose chemotherapy or immunotherapy was given to patients who remain stable over long periods.
Ngoi et al⁴¹	Editorial	Singapore	All staff belonging to the National University Cancer Institute, Singapore (NCIS), with clinical and non-clinical roles, were separated into 2 teams to prevent full departments from being quarantined in the case of COVID-19 Each outpatient part was segregated from the others, with their own registration desks and triage systems to help enable contact tracing Cancer services running within the community were canceled, such as home chemotherapy All face-to-face meetings were canceled, and all departmental meetings were conducted via video calling Telemedicine consultations were conducted Home delivery of prescribed medications was used All patients and visitors to outpatient clinics were screened at 2 points in the hospital via a thermal scanner and health questionnaire. Outcomes: During the 1-month period in which this team segregation method was carried out, 70 COVID-19 testing kits were utilized in the outpatient and inpatient clinics. There was only 1 case of COVID-19 found in the entire unit
Ning et al⁴⁶	Prospective cohort study	USA	Routine appointments were deferred by 2 months Transitioning to telemedicine as implemented Patients were outsourced to local oncology providers Designated contact tracing team were formed to identify staff who are exposed to patients who was tested positive for SARS-CoV-2, which subsequently leads to quarantining of staff Staff were screened for fever and respiratory symptoms and offer staff testing if symptomatic Dual PPE policy was implemented—Patients and clinicians had to wear surgical masks while on site
Onesti et al²⁴	Survey	International	Patients were triaged for signs of infection are observed in more than 90% of centers. Triage was the preferred method in most centers Patients were educated on precautions to avoid contracting COVID-19 is delivered in more than 90% of cancer centers Clinical areas were frequently sterilized in 85% of centers Telemedicine was adopted in 76% of centers 65% of centers required COVID-19 swab tests before admission 50% reduced palliative care admission
Ong et al⁷²	Letter	Singapore	Team segregation was used to ensure continuity of care Outpatient load was decreased and non-urgent cases were deferred to ensure sustainability High patient load was maintained through efficient deployment of manpower within the SPRinT team.
Oualla et al²²	Article	Morocco	Crisis management team was formed Training was given to all staff in the Oncology department Patients were tested before admission and only those who were COVID-19 negative were admitted Face mask-wearing was mandatory for patients and staff Temperature monitoring of patients and staff was implemented Alcohol hand rubs were provided in hospital Reception area and clinical rooms were disinfected The number of accompanying family members was limited All clinical follow-ups were postponed Transition to web-based consultations was implemented Stopping or changing treatment was considered if absolute benefit of treatment regimen is low; Reduce invasive procedures that requires ICU admission For patients with metastatic disease were discussed on case-by-case basis. Discussions considered patients age and comorbidities, considered treatment breaks/oral treatment for indolent and stable disease Palliative care was managed with telephone consultations with home services in patients with high palliative care needs
Patel et al¹⁶	Perspectives	USA	Preoperative COVID-19 testing was offered in 79% of institutions Telemedicine was implemented in most head and neck cancer units implemented Clinical visits were limited through triaging of patients Resident involvement in surgery was limited N95 masks were used for all high-risk procedures in patients who tested negative Treatment decisions were reviewed by multidisciplinary committee
Peeters et al⁶³	Editorial	Belgium	1. Mobile phone apps were developed to monitor treatment toxicity in patients and identify individuals who are at risk of COVID-19 infections
Peng et al⁴³	Comment	China	2. Nation-wide program issued each personnel a health QR code showing a 2 tier contagion risks, which was determined by the number of cases in the area of residency. Medical isolation is required for “high-risk” patients, unless in an emergency 3. Face coverings were required in hospitals 4. Temperature monitoring of patients and staff was implemented 5. Visitors were prohibited in the wards 6. Fever clinics were used to screen patients with suspected COVID-19 symptoms. If cancer patients presented to the hospital with fever, they were attended by an infectious disease specialist before they were seen by oncologists 7. Online consultations were performed Home drug deliveries were done 8. Special programming model was used to aid scheduling of radiotherapy to minimize patients’ waiting time at hospital
Poggio et al⁷⁴	Survey	Italy	Physicians had good awareness of reasonable treatment adaptations without excessively worrying about the negative impact Concerns over potential undertreatment of cancer patients (due to treatment changes) For chemotherapy administration in patients with metastatic disease, oral treatments were considered the preferred choice compared with intravenous agent
Porzio et al²⁹	Perspectives	Italy	Transitioned oncological services to home care under a double triage protocol First telephone interview: Screened for symptoms of COVID-19 the day before scheduled home visit Second telephone interview: Assessed symptom severity (Pain, Eating, Rehabilitation, Sleep, Oxygen, Nausea and Vomiting, Suffering) to determine frequency of home visits needed 9. Outcomes: Good level of patients’ acceptability for telephone interviews
Press et al¹⁸	Technical Report	USA	Patient educational materials were provided Daily symptom screening of patients and close contacts was implemented Sanitization measures were put in place Telemedicine appointments/virtual meetings Visitors were restricted Treatment of indolent diseases was deferred Treatment times were spaced out and waiting rooms were closed Patients in subacute care/nursing facilities were not eligible for treatment until discharged Hypofractionation was used to shorten treatment schedules when feasible. Patients were prospectively monitored on treatment for new symptoms, date of onset, ill contacts COVID-19 test results Treatments for COVID-10 positive patients were deferred and negative test result was needed before treatment could resume. Patients with high-risk exposure were quarantined Outcomes: 11% monitored for symptoms/high-risk exposure 8% of patients had an alteration in treatment plans Out of 11 affected patients, 7 were cleared and rescheduled for treatment (median delay of 7 days), 4 patients were indefinitely delayed (including 3 COVID-19 cases, 1 of which died) Majority of patients who required monitoring had not yet started treatment (60%), all except one were cleared and rescheduled (median delay of 4.5 days) Out of 6 patients on-treatment requiring evaluation (40%), 5 had treatment interruptions and were rescheduled (median delay of 4 days)
Quarto et al⁷⁰	Opinion	USA	Patients were triaged before hospitalization with rapid blood testing for IgG and IgM. COVID-19 positive patients will be quarantined PPE use was made mandatory Robotic surgery was adopted to minimize hospital stay The healthcare system was restructured to manage cancer patients in COVID free hospitals whenever possible
Rathod et al⁵⁰	Short Communication	Canada	New guidelines were issued based on principles of 4R’s for radiation oncology 1. ViRtual care (reduce in-person appointments) 2. Ration radiation (offer radiation wisely and avoid when minimal benefit) 3. DefeR radiation (as appropriate) 4. HypofRactionate radiation (where applicable)
Rodler et al⁴⁵	Perspective	Germany	Urologists who tested negative resumed oncological cancer service on a biweekly rotation Patients who were exposed to infected personnel were found by extensive contact tracing and subjected to strict quarantine. These patients were advised to monitor their symptoms with a symptom diary Symptom checking and side effects monitoring was done through telemedicine; multidisciplinary team meetings were conducted using teleconferences Enrolment in clinical trials was suspended; Study follow-ups were done under virtual care Treatment de-escalation: Immunotherapies were given at prolonged intervals; chemotherapy was subjected to dose reductions Patients were triaged prior to hospital visits; patient companions during visits were prohibited 5. Patients visiting the hospital for systemic treatment were advised to wear surgical masks and were taken to a single room on arrival.
Silvestris et al³⁵	Report	Italy	Cancer surgery: partial home recovery was encouraged with early discharge Patient testing was conducted before surgery; FFP2 masks were worn during surgery Medical therapy: Subcutaneous and oral medications were favored All common areas were closed promptly Patient triage was done in an out-of-hospital tent r multidisciplinary meetings were done by Teleconferencing A cross-departmental commission was established to regularly review hospitalization proposals on a case-by-case basis COVID-19 free hospitals were designated
Tagliamento et al²⁵	Survey	Italy	Testing: 53.8% of healthcare professionals supported testing patients with cancer for SARS-CoV-2 to identify and isolate also asymptomatic carriers before starting treatment with immune checkpoint inhibitors. 97.1% of respondents would not deny ICIs as a treatment option at the time of COVID-19 outbreak ICI given to reduce frequency of hospital visits: 55.8% of respondents (physicians) chose to implement a higher flat-dosing regimen of immune checkpoint inhibitors 31.7% of respondents did not modify the choice of the treatment regimen and the schedule of administration in order to decrease the number of hospital visits Treatment modifications: overall results did not demonstrate a significant change in the attitudes of Italian physicians toward the prescription of immune checkpoint inhibitors during COVID-19 outbreak.
Tan et al⁷	Editorial	Singapore	Staff underwent refresher course on PPE & PAPR and were required to wear a surgical mask or wear full PPE for aerosol generating procedures The number of patients in clinics was reduced and appointment times were spaced out Cross-covering of satellite clinics in cluster hospitals was suspended Multi-disciplinary meetings were conducted via email/teleconferencing Teams were divided to service each treatment site when full segregation of services activated Temperature was checked and logged twice/day on database (staff) Only one person was allowed to accompany patients Declaration form for patients had to be signed at hospital entrances before triage Thermal Scanners were placed at hospital entrance Visitors had to wear surgical masks Non-essential appointments were postponed
Tey et al¹⁰	Perspective	Singapore	Strict visitor screening was implemented Patient triaging with questionnaire and temperature measurement was implemented Universal masking of all visitors was implemented Twice daily temperature monitoring of working staff was done Weekly reviews of availability of medical supplies was conducted Radiotherapy was continued if it has already been started, but new elective new referrals were reduced to high maintenance services (E.g. Brachytherapy) Staff segregation—movement between hospitals was restricted Care teams were formed so 1 team could ensure continuity of service if 1 team requires quarantine Workplace segregation was adopted—2-meter distance between work desks Separate areas for meals were allocated for different clusters of staff
Valenza et al³⁷	Observational	Italy	Filters were applied to and within the hospital, the institution of a surveillance zone to serve both in-hospital and out-of-hospital individuals suspected of having COVID-19, and filters for patients about to undergo surgery. Text messages were sent to those with appointments to contact their doctor if influenza-like symptoms displayed Text messages were sent to those with hospital appointments, asking them to contact their doctor upon experiencing symptoms Those at hospital entrance were filtered out by symptoms and temperature measurements. Surgical masks were distributed Surveillance zones (serve both in-hospital and out-of-hospital patients suspected of having COVID-19 or in need of a differential diagnosis to continue with cancer treatment) was chosen according to – Logistics: Room isolation was considered based on transfer time and distance within the hospital to access CT scanner). Closed-circuit video cameras installed in high care and triage rooms to limit number of nurse visits – Pathways of diagnosis and treatment: pathways and treatment were designed for categories of patients (admitted and at home (under active treatment)). Prerequisite for triage was COVID-19-like symptoms Admission to surveillance area based on decision to start triage, clinical data (vital signs & lung function, scanning) and a multidisciplinary final decision) – Dedicated manpower: rules were set for those taking care of patients. Surveillance team of clinical staff frequented the area to observe the escalation of illness. – Filters were put in place for surgical activity (surgery was verified by cancer board, triage conducted and then tested (if positive, patients are sent home and restaged for symptoms in the following week). However, if the surgery was urgent and the patient had COVID-19, the surgery took place in a dedicated COVID-19 theater Outcome: Overall 33 patients tested positive for COVID-19 (31% of those tested and 11% of those included in the filtering activity report
Van de Haar et al³	Perspective	European countries	Inpatient: Patient triaging was done on the day before hospital admission over phone and at hospital entrance Video consultations were carried out for physicians who had to self-isolate Outpatient: Blood tests were done outside the hospital Interventions were outsourced to private clinics
			Intravenous treatment was converted to oral treatment or subcutaneous treatments Medication was home delivered Considerations were made to postpone surgeries/alternative treatments without compromising clinical outcomes e.g. radiotherapy Cancer patients were transferred from general hospitals treating COVID-19 patients to cancer centers
Van der Lee et al⁶⁴	Correspondence	Netherlands	Cognitive behavioral therapy and psychotherapy was continued with video consultations Outcome: Patient feedback: No travel time means there are less time for reflection after video consultation, Felt distance due to less non-verbal communication
Vanderpuye et al⁴⁰	Editorial	Ghana	West Africa Elective procedures and face to face meetings were suspended Patients were educated on the possible additional risks of COVID-19 infection from chemotherapy Patients with fever were rapidly isolated and were referred to the emergency room for assessment Prescriptions were remotely filled Primary radiotherapy treatments were continued, and patients on concurrent chemoradiotherapy only received radiotherapy. New referrals, including emergencies, were triaged based on the effect of treatment delays on outcomes. South Africa Volume of outpatient follow-ups was reduced Use of adjuvant therapy was reduced as long as risk outweighs the benefits Primary therapy was shortened Sudan All new cases were deferred except for emergency cases Elective surgery, non-urgent chemotherapy and follow up visits were suspended for 2 weeks inpatient visits were limited to 1 visitor per day MDT meetings were done via teleconferencing Medical staff were trained on COVID-19
Wahed et al²⁸	Article	UK	Aerosol generating procedures (e.g. Endoscopy, exercise tolerance tests) were selectively reduced with decisions made by MDT. Patients were isolated for 14 days and offered testing for COVID-19 before surgeries
Wang et al³⁴	Report	China	Body temperature was measured at hospital entrance, wards and outpatient clinics. Contact and travel histories of all visitors and patients were documented An online booking system was used to book appointments to limit number of patients waiting on-site Admitted patients wore masks and were subject to sanitization Cancer patient had online consultations, directing them to take prescribed drugs on time and helping to manage any symptoms Patients: Potential COVID-19 symptoms were registered regularly Patients were required to have blood tests and CT scans of the lungs are taken. If patients were thought to have pneumonia from the scans, then COVID-19 nucleic acid tests were done Anticancer drugs normally administered intravenously were switched to an oral version of the drug, if available Outcomes:2944 were monitored in total from Feb 12-March 2, 2020. 27 patients showed possible changes in the lungs due to pneumonia and 8 of these patients were suspected of being COVID-19 positive. All of these patients were tested with nucleic acid testing and all patient results came back negative. As of March 3, no patient or member of staff tested positive for COVID-19.
Wakefield et al²⁰	Report	USA	Management strategies undertaken in radiation oncology in US: Telecare was quickly adopted 97% of department increased their infection control measures by sanitizing treatment tables (91%), increasing the cleaning of immobilization devices (88%), and requiring patients and staff to wash their hands when entering and exiting treatment vaults (65%) Patients were triaged at the entrance of the facility in 98% of practices. Social distancing was required in majority of clinics (98%), Mask wearing was required (82%) 98% of practices reported increased measures for the protection of staff, including requiring all staff to wear masks (99%) Increased cleaning (95%) Screening staff at the beginning of each shift (91%), and testing symptomatic staff (93%). Some practices required gloves (72%), face shields (50%), and gowns (22%) during treatments and procedures, as well as staggered shifts of limited staff (50%).
Wei et al⁷¹	Letter/Survey	China	A survey was conducted to assess the radiotherapy implementation status in 74 Chinese hospitals: 88% of surveyed hospitals provided radiation treatment for COVID-19 negative patients 39% of hospitals would not treat COVID-19 patients even if they have been cured. Hospitals recommended that patients took the stairs, sterilizing handrails 50% disinfected treatment bed and surrounding accessories during treatment intervals
Weisel et al⁸	Perspectives	Germany	A multidisciplinary leadership task force was established to discuss treatment plans on a case-by-case basis Outpatient care was replaced with telemedicine Staff and patients were trained to practice social distancing at outpatient departments Elective surgeries were reduced to make way for necessary cancer surgery Frequent staff testing was provided for those with suspected contact with COVID-19 patients Physicians were assigned a designated replacement staff in case of quarantine Outcome: Reduction in outpatient visitors by 40-50% per week 6 cancer patients and 5 staff members were tested COVID-19 positive
Wilkinson⁴²	Editorial	UK	1. COVID-19 free cancer center was established Patients were quarantined and tested before surgery Clear guidance was issued on patient prioritization (3 tier system arranged according to urgency of treatment) Phlebotomy service allowed patients to wait in their cars for their turns Treatment adaptation: immunosuppressive treatments were reduced Regular weekly staff testing was implemented Phone calls prior to appointments were made for patient reassurance Rapid diagnostic clinics were held virtually to deal with new referrals
Wilson³⁰	Report (gray literature)	UK	Single point entry to the hospital was instated, where all patients and visitors were screened Oncology and hematology wards on separate levels were repurposed into a clean ward for patients who had tested negative and a second ward for patients awaiting test results face to face outpatient clinic appointments were almost entirely replaced by to telephone-based consultations almost entirely All intravenous anti-cancer treatments were moved off-site
			Treatment adaptations Standard prescription length for some oral medications was increased to reduce appointments Medications including oral anti-chemotherapy were sent to patients’ home addresses Patients established on immunotherapy were switched to longer regimens Team restructuring: Separate staffing was adopted for clean, potential positive and confirmed positive areas Separate consultants provided inpatient cover to clean and positive areas Junior doctors covered all inpatient areas onsite 24 hours a day Shadow rota was implemented to cover sickness or self-isolation Task groups were set up between registrars, consultants, senior nursing staff and management to facilitate rapid decisions and communication
Wu et al⁴⁴	Perspectives	China	Patient and healthcare worker screening was undertaken Health education for patients: patients signed a consent form before therapy and were informed of the risk of cross-contamination during treatments and the zoning design of center. Staff were trained on personal hygiene, prevention and protection. Staff learned about the appropriate personal protection for the role Special radiotherapy workflow was adopted to avoid patient-patient contact and minimize patient-staff interaction time. Departments were divided into zones according to different contamination levels
Yusuf¹³	Editorial	Pakistan	Well-developed textile companies were enlisted to help speed up the production of protection gowns and N95 masks Only essential imaging studies were performed. Elective imaging and endoscopy surveillance were stopped All hospital visitors were triaged to quickly screen for respiratory symptoms at hospital entrance. High-risk patients were transferred to temporary triage areas Outpatient services were continued virtually Treatment adaptation: Oral medication was preferred over ablative procedures for hepatocellular carcinoma to minimize hospital visits