key: cord-1021193-buf8pqsh
authors: Koontz, Bridget F.
title: Through COVID-Colored Glasses: New Perspectives on Same Data
date: 2020-10-01
journal: Int J Radiat Oncol Biol Phys
DOI: 10.1016/j.ijrobp.2020.07.011
sha: 4698e1b398c893e60b02388a369c4a13349ae896
doc_id: 1021193
cord_uid: buf8pqsh

nan

Through COVID-Colored Glasses: New Perspectives on Same Data Before COVID-19, my recommendation for this man 1 (at his first diagnosis) would have been moderately hypofractionated radiation therapy (RT) (70 Gy in 28 fractions) and short-term androgen deprivation therapy (ADT). With re-biopsy, I agree with the treatment option of RT and longterm ADT. I will admit to being a slow adopter of prostate stereotactic body radiation therapy for intermediate-risk disease, although with the HYPO-RT-PC trial's publication, 2 I have been offering it more frequently. I will also say that in my practice at a community hospital within an academic enterprise, serving a varied socioeconomic base including the surrounding rural counties, the patient tolerance for toxicity and novel treatments is low.

COVID-19 and the significant concern about exposure felt by my patients with cancer has changed my practice. First, I offer a longer delay between start of ADT and RT. Second, although I have generally been a proponent of elective nodal irradiation, I have foregone that coverage in all but a few select patients, and only after discussion with them about potential risks/benefits. Third, I have found patients more willing to try stereotactic body radiation therapy for the reduced number of visits, although I would not offer it for high-risk patients (underrepresented in HYPO-RT-PC, significant variability within the traditional National Cancer Comprehensive Network high-risk cohort such that I do not know yet which men can be treated with tight fields).

Our institutional policy has been to not test asymptomatic radiation therapy patients for SARS-CoV-2 unless they have a known exposure or high-risk living situation. That may have changed between this writing and publication owing to community spread or other updates. The fundamental question is how will a delay in treatment affect outcomes. Treatment delays may lower the risk of contracting and dying of COVID-19 by allowing the peak of the pandemic to pass, but they have the potential to increase cancer-specific mortality (CSM). Our team has created an integrated model to provide quantitative estimates of the net impact of treatment delay on overall mortality (http://onccovid.med.umich.edu/). Using the following assumptions, if the patient has 1 additional comorbid condition and lives in San Mateo, California, and assuming a COVID-19 replication rate (R 0 ) of 2, 1 we would estimate the patient's

7% (CSM þ other-cause of mortality)

age-and comorbidity-adjusted COVID-19especific mortality to be 13.9%

What would you do? Continue the discussion on Twitter at #gyzone, and take the poll at www

0360-3016/$ -see front matter Ó