key: cord-1047516-mfdaj41w
authors: Merlotti, Anna; Taglianti, Riccardo Vigna; Melano, Antonella; Reali, Luca Gianello Alessia; Petrucci, Rachele; Russi, Elvio Grazioso
title: Letter to the editor regarding wei w et al.: “Experience of the hubei cancer hospital in wuhan, china”
date: 2020-07-01
journal: Radiother Oncol
DOI: 10.1016/j.radonc.2020.06.035
sha: eb68ba4d0df09dbb446f4be01714160d3c58e85d
doc_id: 1047516
cord_uid: mfdaj41w

nan

Procedures During the Coronavirus Disease 2019 (COVID-19) Outbreak: Experience of the Hubei Cancer Hospital in Wuhan, China." describing multiple measures for patient and staff COVID-19 protection and prevention at the Hubei Cancer Hospital" [1] . This paper is of great interest, and it points out three key points: patient protection, staff protection, and avoiding the spread of infection. We believe that patient protection also includes preventing his risk of dying from cancer from increasing due to suspension or delays. The choice to compartmentalize the staff and to rotate them every week certainly has a rationale in preventing the spread of infection among operators but also requires reducing the LINAC activity because the active workforce is halved. The Authors report that they "treated roughly 1/7 of the regular patient load and with lower risks for infection, up to 1/3 of the regular patient load", which means that with the proposed organization, a large number of patients cannot receive the radiotherapy treatment they could benefit. In a recent Italian Survey only 38% of the centers reduced their activity of more than 10%, and only one out of 125 centers defined two working teams who never meet each other and by extending the working time [2] . We agree that COVID-19 screening is mandatory, but the chest CT required for inpatient admission and for the accompanying caregivers to enter treatment areas seems unreasonable and unwarranted. The execution of a CT in people who are not cancer patients contradicts the principle of radiation protection of the appropriateness of the investigation. Furthermore, the situation photographed on the day of the patient's first access does not constitute a guarantee that the patient is at an early stage of the infection without radiographic signs or that he will not contract the infection during the treatment; in fact, the Author report that: "4 patients were identified as asymptomatic positives who all showed normal chest CT and blood test results". In our opinion, the most controversial problem is the management of patients who begin treatment who develop mild symptoms / signs of infection for whom the risk of stopping treatment outweighs those associated with the infection. The Authors state that "for patients exhibiting COVID-19 symptoms after admission, observation in single-occupancy isolation was conducted for 14 days". It is not clear whether the treatment, if it was already in progress, was suspended for 14 days. This is debatable as interruptions are recognized as detrimental for the aim of curative treatments. In conclusion, these months have made it necessary to change the working methods of the oncological radiotherapy departments. These changes require reflection to make them sustainable in the long run. The prediction of a long coexistence with the SARS-CoV-2 virus requires us to balance the pros and cons of our every decision carefully.

Radiotherapy workflow and protection procedures during the Coronavirus Disease 2019 (COVID-19) outbreak: Experience of the Hubei Cancer Hospital in Wuhan, China

COVID-19 outbreak and cancer radiotherapy disruption in italy: Survey endorsed by the italian association of radiotherapy and clinical oncology (AIRO)

Elvio Grazioso Russi. Department of Radiation Oncology, S. Croce and Carle Teaching Hospital