Mitigating the Impact of COVID-19 on Oncology: Clinical and Operational Lessons from a Prospective Radiation Oncology Cohort Tested for COVID-19

Ning, Matthew S.; Frances McAleer, Mary; Jeter, Melenda D.; Minsky, Bruce D.; Ghafar, Robert A.; Robinson, Ivy J.; Nitsch, Paige L.; Zaebst, Denise J.; Todd, Sarah E.; Nguyen, Jennifer; Lin, Steven H.; Liao, Zhongxing; Lee, Percy; Brandon Gunn, G.; Klopp, Ann H.; Dabaja, Bouthaina S.; Nguyen, Quynh-Nhu; Chronowski, Gregory M.; Bloom, Elizabeth S.; Koong, Albert C.; Das, Prajnan

BACKGROUND AND PURPOSE: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures and quarantines. MATERIALS AND METHODS: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). RESULTS: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (including 4 warranting intensive care), 2 of whom died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to ≤1-day (P<0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75-5) to 1 business day (IQR: 1-2) [P<0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3-6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2-11), with a peak of 17 employees simultaneously quarantined. Following implementation of a “dual PPE policy,” newly quarantined employees decreased from 2.9 to 0.5 per day. CONCLUSION: The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.