key: cord-285060-hzyf7w0k authors: Cruz, Misael C.; Flores, Jerickson Abbie S.; Paule, Jerome R.; Macalalad, John Michael; Lacuesta, Angela Vichelle A.; Francisco, Melania C.; Agustin, Mary Ann Rose D.; Banuelos, Gonzalo C.; Sarmiento, Thelma S.; Villegas, Fritzie C.; Tangco, Enrico D.; Olvina, Marigie C.; Aguilar, Carl Ruperto P.; Pusag, Cynthia T.; Enriquez, Katherine S.; Lo, Karl Jeremy B.; Ramos, Jaemelyn Marie F. title: Adapting to the contemporary normal in cancer management and workflow during COVID-19 situation in the Philippines: Multi-cancer center collaborative approach date: 2020-06-13 journal: Radiother Oncol DOI: 10.1016/j.radonc.2020.06.008 sha: doc_id: 285060 cord_uid: hzyf7w0k • Cancer management adapting to the current state of health during COVID-19 pandemic. • Collaborative strategic action plan for cancer management and workflow in a developing country. • Algorithm in cancer center management during COVID-19 in a developing country. • Measures to be adopted in cancer management and workflow after COVID-19 pandemic. All authors declare no conflict of interest Phase I shows the triage for presence or absence of COVID-19 based on exposure and symptoms. Phase II shows patient with COVID-19 exposure/symptom will be classified as no covid, suspect, probable and confirm 3 , while those without exposure/symptoms will proceed to the required treatment modality and be classified as new, ongoing and follow up. Phase III shows the treatment management process for those with confirmed COVID-19, and those who will proceed with chemotherapy or radiation therapy. Phase IV includes the disposition plan after intervention for confirmed COVID-19, and resumption of regular schedule for chemotherapy or radiation therapy for those without COVID-19 (Figure 1 ). Everyone will be screened at the triage area and will fill up a COVID-19 screening information record (Figure 2 ) based on the department of health (DOH) decision tool 3 . Patient with respiratory symptoms, with history of close contact to COVID-19 positive patients, and with travel history to areas with high incidence of COVID-19 were not allowed to enter the cancer center. Evaluation will be done by the infectious control officer at the emergency room 4 . Only staff on duty, patients, and one relative were allowed inside the cancer center premises, and a physical distance of at least 1 meter apart is observed 5 . No mask, no entry policy was implemented. Patients were instructed to bring their own alcohol or hand sanitizers, and blanket during treatment. Sanitation of treatment couch, and bed was done after every patient using proven sanitizers 6 . Patient prioritization protocol for planning, and start of radiation therapy was based on the following case category 7-10 : 1. Urgentsuperior vena cava syndrome, cord compression, pain, bleeding, life threatening symptoms, brain metastases, and patients coming from remote places were scheduled on the same day or the day after consultation 2. Semi urgentcolorectal, concurrent protocol, head and neck, cervical, and lung were scheduled two to seven days after consultation 3. Not urgentbreast, prostate, endometrial, post-operative, skin, and asymptomatic brain were scheduled eight to ten days after consultation Patient prioritization for chemotherapy was based on tiered approach of the European Society of Medical Oncology categorized as high, medium and low priority 11 . Walk-in and new patients were scheduled during the clinic hours of the attending oncologist. Physical check-up of patient was limited, and teleconsultation was encourage using the platform https://doxy.me 24,25 . Patients classified as suspected/probable/confirmed COVID-19 will follow the infectious control committee protocol based on DOH-Philippine Society of Molecular and Infectious Diseases guidelines 4 . Oncologist and referring physician will consider the risk for both patient and staff and decide the need to pursue chemotherapy or radiation therapy 5, 8, 14 . IgM and IgG Rapid Diagnostic Test (RDT) was used as an initial test for COVID-19 because real time reverse transcription-polymerase chain reaction test (rRT-PCR) which is the gold standard for confirmation of COVID-19 is not readily available and accessible. Patient with negative RDT results but with significant symptoms must be re-tested using rRT-PCR 4 . A dedicated nurse on full PPE will handle confirmed infected patients for chemotherapy in an isolation room with a separate entrance and exit. No relatives nor visitors will be allowed. In case radiation therapy maybe life-saving, COVID-19 patients will be the last one to be treated and/or on a separate machine if available. Otherwise, priority in delaying or stopping radiation therapy is considered. Clinical staff, cashier, and coordinators reports on a skeletal force while administrative, marketing, human resources, and finance will work from home as part of the modified working shifts. Limited supplies of PPE were outsourced and the rest comes from donations. Ultraviolet light was used to sanitize PPE and washing was done so they can be re-use. The prescribed suit specifications were: Chemotherapy and brachytherapy were transformed into sterile area. Transparent acrylic or plastic shield for the triage, reception, cashier and nursing area were constructed for protection between personnel and patient. This collaborative cancer management strategic action plan and workflow attempts to answer the uncertainties of this pandemic despite faced with meager resources. It may guide cancer centers from developing countries on how to adapt during these current adversities. We recommend adopting the following in the contemporary normal period: Philippine Radiation Oncology Society (PROS) COVID-19 General Recommendations Philippine Society of Medical Oncology (PSMO) Guide on cancer care in the time of Covid-19 Pandemic. Official communication Department of Health (DOH) Philippines decision tool for coronavirus disease 2019 (COVID-19) assessment Department of Health (DOH) Philippines office of secretary department memorandum no.2020-0138. Adoption of PSMID Clinical Practice Guidelines on COVID-19 Article in Press 6. Department of Health (DOH) office of secretary, department memorandum no. 2020-0157, Guidelines on cleaning and disinfectant in various settings as an infection prevention and control measure against COVID-19 Brutal' plan to restrict palliative radiation during pandemic Cancer guidelines during the COVID-19 pandemic Global radiation oncology's targeted response for pandemic preparedness COVID-19 rapid guideline: delivery of radiation therapy Cancer patient management during COVID-19 pandemic DOH office of secretary memorandum circular no. 2020-0016 Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China Manual for the depression anxiety & stress scales 1995  Cancer management adapting to the current state of health during COVID-19 pandemic  Collaborative strategic action plan for cancer management and workflow in a developing country  Algorithm in cancer center management during COVID-19 in a developing country  Measures to be adopted in cancer management and workflow after COVID-19 pandemic