Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
JCO Glob Oncol. 2021 Jan;7:99-107. doi: 10.1200/GO.20.00433.
A COVID-19 lockdown in India posed significant challenges to the continuation of radiotherapy (RT) and systemic therapy services. Although several COVID-19 service guidelines have been promulgated, implementation data are yet unavailable. We performed a comprehensive audit of the implementation of services in a clinical oncology department.
A departmental protocol of priority-based treatment guidance was developed, and a departmental staff rotation policy was implemented. Data were collected for the period of lockdown on outpatient visits, starting, and delivery of RT and systemic therapy. Adherence to protocol was audited, and factors affecting change from pre-COVID standards analyzed by multivariate logistic regression.
Outpatient consults dropped by 58%. Planned RT starts were implemented in 90%, 100%, 92%, 90%, and 75% of priority level 1-5 patients. Although 17% had a deferred start, the median time to start of adjuvant RT and overall treatment times were maintained. Concurrent chemotherapy was administered in 89% of those eligible. Systemic therapy was administered to 84.5% of planned patients. However, 33% and 57% of curative and palliative patients had modifications in cycle duration or deferrals. The patient's inability to come was the most common reason for RT or ST deviation. Factors independently associated with a change from pre-COVID practice was priority-level allocation for RT and age and palliative intent for systemic therapy.
Despite significant access limitations, a planned priority-based system of delivery of treatment could be implemented.
印度的 COVID-19 封锁对继续进行放疗 (RT) 和系统治疗服务带来了重大挑战。尽管已经发布了几项 COVID-19 服务指南，但实施数据仍不可用。我们对临床肿瘤学部门的服务实施情况进行了全面审核。
制定了基于优先级的治疗指导部门方案，并实施了部门员工轮班政策。收集了封锁期间的门诊就诊、RT 和系统治疗开始和交付的数据。通过多变量逻辑回归分析，对遵守方案的情况进行审核，并分析影响从 COVID 前标准改变的因素。
门诊咨询减少了 58%。1 级至 5 级优先级患者中，有 90%、100%、92%、90%和 75%的患者实施了计划的 RT 开始。尽管有 17%的患者推迟了开始，但辅助 RT 的开始中位时间和总治疗时间保持不变。有资格接受同步化疗的患者中有 89%接受了化疗。计划患者中有 84.5%接受了系统治疗。然而，33%和 57%的根治性和姑息性患者在周期持续时间或延迟方面有改变。患者无法前来是 RT 或 ST 偏差的最常见原因。与 COVID 前实践改变相关的独立因素是 RT 的优先级分配以及系统治疗的年龄和姑息治疗意图。
尽管存在严重的就诊限制，但仍可以实施计划的基于优先级的治疗交付系统。
