Radiation treatment is an important integral constituent
of majority of cancer patients overall management
plan. It represents as a core component in
comprehensive multi-disciplinary cancer care. Pakistan
being among the lower- and middle-income
countries, is already finding difficulty in coping with
management of approximate 148.041 new cases per
year and their need for radiation therapy (RT) due to
lack of resources not only in terms of equipment but
also in terms of trained personnel.[
Restrict Access to Radiotherapy Department
• Screening of patients and their attendant at two different
levels for symptoms such as fever, cough, and
lethargy and any contact with patient diagnosed
with COVID 19,
• Only one attendant is allowed to accompany patient
if required.
Staff and Patient Safety
• Gloves have to be changed after each patient interaction,
• To ensure cleaning of treatment couch and accessories
after each patient as contact precaution using
alcohol swab,
• Schedule off days are assigned for physicians, clinical
medical physics, radiation therapist, and allied
staff to ensure minimal exposure and obtain best
productive output without compromising patient
care (the fewer the better),
• All academic or service related meetings are
switched to online sessions,
• Polymerase chain reaction testing for COVID-19
has been made mandatory before starting radiation
treatment,
• Any patient who attains COVID 19 infection during
treatment is referred to infectious department. The
treatment of patient is hold till clearance from infection
department. All staff members who were in contact
with the affected patient are advised to undergo
screening through employee health screening system,
• A central screening application has been developed
by institution for health-care provider to ensure
safety of all health-care professionals.
On Treatment Patients Review
Ongoing Patient Triage and Start of New Patients
1. No Delay in Radiotherapy Treatments
• Definitive external beam radiotherapy in radical
setting in rapidly proliferating tumors where there
is little or no scope for gaps compensation,
• Brachytherapy, where it is the part of management
plan in definitive setting (e.g., cervix cancer),
• Emergency situation such as spinal cord compression
and brain metastasis to salvage neurological
function.
2. Consider Delay in Radiotherapy Treatment
• Patients who need RT in adjuvant setting where
there is known residual disease or positive margins
following surgery in tumors with aggressive biology
• Brachytherapy in adjuvant setting.
3. Can Delay Radiotherapy Treatments (Non-urgent
and Deferrable)
• Radiotherapy of patients who are receiving hormone
therapy for prostate cancer.
4. Postponement of Radiotherapy
5. Consultation For New Patients
Outpatient/Inpatient Consults
• For outpatient consults, attending will consult over
the telephone/video. After consultation, if the consultant
believes that a patient needs physical evaluation,
then patient will be asked to visit clinic accordingly,
• If patients want to see doctor in clinic resident will
take history and physician will discuss the management
plan on telephone. Attending will see patient
briefly in clinic to minimize the exposure.
• Reduction of unnecessary access to radiotherapy
facility,
• Staff need to ensure wearing surgical masks, gown,
gloves, and face shields with patient interaction,
• Attending/resident will interact with patients over
telephone to review on-going treatment patients.
Doctor will do physical evaluation along with precautionary
measures, only if it is clinically indicated.
• All pediatric patients,
• Radical radiotherapy for less-aggressive tumors for
which radiotherapy is used in definitive treatment
setting (e.g., prostate cancer),
• Adjuvant radiotherapy of breast cancer patients,
• Postpone radiotherapy treatment for all palliative
patients where alternate treatment is available (e.g.,
RT for bleeding control, pain management),
• Recommendations for inpatient consults may be
given over the telephone. Doctor will see patient
along with precautionary measures, only if it is indicated,
• Keep yourself at a distance of 1 m, no handshake or other contacts and frequent washing hands
• Less trafficking within hospital premises
• Use of room and equipment disinfection
• Use of surgical masks for cancer patients and personal protective equipment for cancer care providers
• Minimize the contact between patients and health care providers
• Make a contingency plan for cancer patients. (Delay of treatments for low-priority case, favor shortterm treatment regimens, Delay follow-up visits, and use phone contacts).
