COVID-19 outbreak and cancer patient management: Viewpoint from radio-oncologists.

COVID-19 has emerged as a major global health threat since December, 2019. By April 1st, 2020, there were more than 800,000 patients with confirmed COVID-19 infection worldwide. Radiotherapy is continuous in treatment schedule. Interruption of the treatment or delay of the treatment may jeopardise therapeutic efficacy. Liang et al. [1] demonstrated that due to receipt of immunotherapy, cancer patients are at higher risk to be infected with COVID-19. Recently, Xia et al. [2] revealed cancer patients older than 60 years old have an excess risk of COVID-19 infection, which deserves special attention. Filippi et al. [3] pointed out that as a cancer-specific treatment, radiotherapy must be applied to patients with indications. Achard et al. [4] proposed that shortening treatment course can provide the essential treatment of cancer patients, reduce the possibility of COVID-19 exposure and lower the risk of COVID-19 infection at the same time.

We developed a questionnaire to learned about the physical and metal situation of patients undergoing radiotherapy. Overall, 101 questionnaires were obtained. Detailed information is presented in Table 1 . Our center puts forward the following suggestions regarding treatment of patients with indication for radiotherapy. Ethical approval of the current study was obtained from the local ethics committee.

Table 1

Characteristics of the patients with cancer patient undergoing radiotherapy.

Characteristics	No. of patients, n (%)
Gender, n (%)
Male	17 (16.8%)
Female	84 (83.2%)
Age, median, year (range)	49.6 (12–83)
Recidence, n (%)
Local	51 (50.5%)
Non-local	50 (49.5%)
Education level, n (%)
Bachelor degree or above	49 (48.5%)
Secondary schools	44 (43.6%)
Primary school and below	8 (7.9%)
Habitat, n (%)
Urban	90 (89.1%)
Rural	11 (10.9%)
Diagnosis, n (%)
Breast cancer	40 (39.6%)
Cervical cancer	33 (32.7%)
Endometrial cancer	5 (5%)
Prostate cancer	4 (3.9%)
Others	19 (18.8%)
Disease stage, n (%)
I	29 (28.7%)
II	30 (29.7%)
III	30 (29.7%)
IV	11 (10.9%)
Cannot be staged	1 (1%)
Current state, n (%)
After radiotherapy	13 (12.9%)
During radiotherapy	82 (81.2%)
Has not start radiotherapy	6 (5.9%)
Cardinal symptoms at present, n (%)
There was no obvious discomfort	35 (34.7%)
Lack of strength	18 (17.8%)
Pain	9 (8.9%)
Insomnia	8 (7.9%)
Diarrhea	4 (4%)
Bleeding	1 (1%)
Weight loss	1 (1%)
Others	25 (24.8%)
How to see a doctor
Wechat consultation	41 (39.8%)
Non-pneumonia designated hospital	25 (24.7%)
Telephone consultation	23 (22.3%)
Internet online consultation	18 (17.5%)
Go to the drugstore	4 (4%)
Expert webcast	3 (3%)
Other	25 (24.3%)

Differential diagnosis

Acute radiotherapy pneumonia should be differentiated from COVID-19 pneumonia. According to the “Diagnosis and Treatment Protocol for COVID-19 (Trial Version 7)”, radiotherapy should be suspended or postponed among patients with fever. At the result of nucleic acid detection confirmed or suspected of COVID-19 infection, the patient will be transferred to the designated COVID-19 hospital for treatment.

Make individualized radiotherapy plan

For patients with alternative therapy, radiotherapy is not recommended for the time being. Informing patients of the advantages and disadvantages of the radiotherapy, could help patients learn about the decision of the radio-oncologists. For patients indicated for adjuvant radiotherapy, postponing the start of radiotherapy until the epidemic is stable or even after the end of the epidemic is a reasonable choice. For patients indicated for neoadjuvant radiotherapy, appropriate extension of the course of oral chemotherapy can be an alternative approach. For individuals with emergent radiotherapy indications, radiotherapy should be intervened immediately.

Optimize the treatment mode

Treatment segmentation and dose could be adjusted by two or more experienced radio-oncologists. Stereotactic radiotherapy and shortening the course of treatment could also be considered based on evaluation of patient COVID-19 exposure risk.

Follow-up schedule

For patients with stable disease, the follow-up period should be more adjustable. For example, within the first two years after radiotherapy completion, the follow-up could be every 3–6 months. It is reasonable to postpone their next follow-up after the control of COVID-19 pandemic.

Diagnosis and treatment mode

With the help of tools like Wechat and network video phone, online multi-disciplinary treatment can be held to discuss the most optimal treatment plan for the patient, not only reduce the gathering but also decrease the possibility of COVID-19 infection.

Psychological counseling

Online health education and counseling could be performed regarding treatment principles, psychological counseling, nursing guidance and so on to lower the risk of anxiety and depression in cancer patients.

CRediT authorship contribution statement

Hongnan Zhen: Writing - review & editing. Fuquan Zhang: Supervision. Hui Guan: Writing - review & editing. Zhikai Liu: Writing - review & editing. Jie Shen: Data curation. Xiaorong Hou: Data curation. Xin lian: Data curation. Ke Hu: Supervision.