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COVID-19: How to Mitigate your Radiation Oncology Clinic Risk?


Article - COVID-19: How to Mitigate your Radiation Oncology Clinic Risk?

The COVID-19 pandemic has hit the world and it is impacting every aspect of life creating fear and anxiety. This pandemic impacted Cancer patients, their families, and caregivers disproportionally and Cancer patients are twice as vulnerable to get infected as the general population.

There are two different strategies for patients who are diagnosed with cancer to reduce their risk during the pandemic:

  • Take appropriate precautions to avoid unnecessary exposure to the virus.

  • Changes could be done in their treatment to reduce their risk of infection.

Stress on Radiation Oncology clinics due to COVID-19

A new virus called COVID-19 causes respiratory illness in people and spreading from person-to-person. In December 2019, Wuhan, China witnessed the outbreak of the novel coronavirus (SARS-CoV-2) that is an international public health emergency and world pandemic now.

 

This virus quickly spread throughout China and other countries including the United States. Various Doctors and society are working to understand the disease, develop new treatments, and recommend behavioral changes to reduce the risks of transmission and infection.

 

Individuals with weakened immune systems such as cancer patients are high on risk to develop COVID illness. Based on available data, the impact of patients both at risk for and positive for COVID-19 will be felt throughout oncology clinics. 

 

The burden this may place on radiation oncology clinics is of particular concern owing to the potential need for screening of patients for daily treatment, treatment interruptions, delays in restarting treatment, and a decreased workforce.

 

The virus is primarily spreading via respiratory droplets when an infected person coughs or sneezes.

Let’s look at the spread and prevention of COVID-19 in detail:

The spread of COVID-19 and its prevention for oncology clinics

The virus is transmitted via respiratory droplets that can land in the mouths or noses of people who are nearby or can possibly be inhaled into the lungs. Moreover, the reason behind spread is touching a surface or object that has COVID-19 on it and then touching one’s own mouth, nose, or eyes. 

It is therefore imperative that patients with cancer be prevented from assembling in areas with potential carriers, which means controlling exposures in waiting rooms and treatment areas in radiation oncology clinics. 

Various precautionary measures such as screening of patients for symptoms upon entering a clinic and immediate isolation and contact precautions for patients suspected should be followed in a health care setting for patients with cancer. For COVID-19, suspicion for infection would be high in patients with fever, cough, shortness of breath, and a history of recent travel to high-risk areas.

 

Treatment interruptions due to COVID-19 on Radiation oncologists

Radiation oncologists have to prepare for treatment interruptions caused by the development of COVID-19 in patients with cancer. Patients, who test positive for the novel coronavirus will, at a minimum, require 14-day quarantine per CDC recommendations.

 

Patients with a weakened immune system may be at greater risk of infection due to their defenses against infection is lowered. Blood-related cancers such as leukemia, lymphoma, or multiple myeloma, that undergoing chemotherapy treatment, individuals with more advanced disease, and those with cancer involving the lungs are most vulnerable.

 

Treatment interruptions would be of highest concern in tumors for which treatment package time significantly affects outcomes, such as head and neck and cervical tumors, lung tumors, and other thoracic tumors. Moreover, Treatment delays may also be due to strains on the health care system in the setting of a pandemic due to travel restrictions, availability of workforce, and/or lack of access to hospital care.

 

To avoid such delays let’s see what measures are taking Radiation Oncology Clinic?

What is the Radiation Oncology Clinic Doing?

Radiation Oncology Clinic adopting a measure to improve patient safety by decreasing the risk of exposure to the virus:

  • Delaying non-essential clinic visits.

  • Use of telemedicine appointments when possible.

If the clinic or hospital visits are necessary:

  • Wear a mask or facial covering.

  • Practice physical distancing.

  • Clinics are screening for exposures either at clinic entrance checking for fever, cough, and other symptoms.

  • Minimizing visitors

  • Increasing the interval between visits when possible

 

Apart from above mentioned activities, now let’s look at different strategies for mitigating risk.

COVID-19 radiation oncology clinic risk mitigation strategies

Screening

  • Include risk screening questionnaire form along with routine review-of-system and medication update form

  • Develop external exposure risk questionnaire for front desk staff to screen patients during time of appointment scheduling and check-in

Sanitation

  • Encourage and enforcement of hand-washing guidelines

  • Implement increased sanitation precautions for simulation/therapy equipment with multiple patient exposures

  • Removal of unnecessary items from waiting rooms, such as magazines

  • Instruct patients to wash hands upon entering department

Containment

  • Infected patients who cannot halt/postpone treatment must wear appropriate personal protective equipment during all phases of treatment

  • Staff who must interact with patients who cannot halt/postpone treatment must wear appropriate personal protective equipment during all phases of treatment

Exposure

  • Rather than in-person follow up consider phone call or telemedicine follow-up if sufficient for a patient/clinical scenario

  • Any patient or staff member with exposure should be offered testing according to CDC/hospital guidelines

In-person visit for radiation oncology clinics

Radiation oncology clinics require rescheduling of nonessential follow-up visits or diverting these visits to telemedicine if available a large proportion of our patients are elderly, discretion is needed to protect this vulnerable group from exposure. In addition to this, a large proportion of patients are old people, hence discretion is needed to protect this vulnerable group from exposure.  

Patients with no evidence of disease or concerning symptoms should be considered for rescheduling the visit if all clinical, laboratory, and imaging data suggest low risk for recurrence. However shortage of health care workers in radiation oncology clinics may be concern for the patients.

 

Decreased Workforce is major concern for radiation oncology clinics

A study shows that 63% of health care workers became infected, and 14.8% of cases in health care personnel were severe or critical. Although it is too early to predict how this will affect the US workforce, the number is suggestive of a great potential for a shortage of healthcare providers.

Same as patient’s health care workers are at risk for possible quarantine or hospitalization. Additionally, some clinicians will remain home to serve as caregivers for others who are ill hence we need to adapt accordingly.

Other measures such as strict travel restrictions, identification of back-up staff or consideration for staff teams who can rotate to retain a team at all times should be considered.

 

After following all the instructions, radiation oncology clinic should follow some of the management strategies for managing Covid-19 patients

 

Management of Covid-19 patients

COVID-19 positive patient to a radiation oncology clinic poses significant challenges to the staff, administration, and physician who are charged with infected patient’s care and well-being and the care and well-being of other patients.

Professional societies, including the American Society of Radiation Oncology (ASTRO), are working hard to develop useful and evidence-based guidelines for the management and care of patients.

 

Oncology clinics should look at these updated guidelines as they are released for the most up-to-date and informed management information.

Radiation Oncology clinics have always functioned as an interdisciplinary team of support staff, nurses, therapists, physicists, and physicians who are aiming to help patients ailing from cancer. During the COVID-19 pandemic, this team’s efforts and vision to protect cancer patients remain critical.

 

We Medical Billers and Coders (MBC) offers oncology management, radiation oncology billing to assist physicians and hospitals in reducing financial anxiety so that they can improve their level of service and increase the value of their oncology department.

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