From Alpha to Omicron: A Tertiary Care Hospital-Based Radiation Oncology Network's COVID-19 Response Experience

Abstract

Purpose/Objective(s)The COVID-19 pandemic completely altered access to medical care, severely limiting or halting outpatient procedures over long periods of time. However, it was clear that radiation therapy needed to remain available to patients. We implemented asymptomatic testing algorithms and constructed negative air pressure CT simulator and treatment rooms within our tertiary care hospital-based Radiation Oncology network to accommodate the safe treatment of patients affected by the COVID-19 pandemic.Materials/MethodsOur Radiation Oncology department undertook dedicated construction to convert select CT simulator rooms and treatment vaults into negative pressure environments, including one CT simulator room and photon-based linear accelerator treatment vault at the main campus in 5/2020; and one CT simulator room, two photon-based linear accelerator vaults, and a single proton therapy gantry between two regional campuses in 12/2021. From 5/18/20 to 9/7/21, an asymptomatic screening protocol was implemented for all patients prior to initiation of radiation therapy. Patients with COVID-19 infection and Persons Under Investigation (PUIs) could undergo simulation and/or treatment in the newly constructed biocontainment environments at the discretion of the treating physician with guidance from a predefined priority scale. A biocontainment treatment protocol delineated specific roles within a treatment team of one Nursing Safety Officer, one Direct Contact Radiation Therapist, and one Indirect Contact Radiation Therapist. Safety drills were performed to establish and practice safe pathways for escorting patients directly from their car to the treatment room, and vice versa, for the last treatment slot(s) of the day. Patients who were treated under COVID-19 protocol from 6/2020 to 1/2022 were chart reviewed to assess utilization of our newly constructed and developed biocontainment resources.ResultsA total of 6,525 patients were treated from 6/2020 through 1/2022 across our 5 campuses. During this time, 42 patients were treated under the COVID-19 biocontainment protocol. All but 3 had documented personal COVID-19 positivity, while the others were designated as PUI, typically for COVID-positive household contacts. For 61.9% of patients, these safety measures mitigated the need for extended breaks during treatment courses that had already been initiated. The majority (64.3%) of patients were being treated with curative intent, while 10 patients (23.8%) were treated as a result of an inpatient palliative consult. A third (35.7%) were transferred from a regional campus to the main campus for management prior to expansion of biocontainment resources. The median number of biocontainment sessions required by each patient was 6 (range: 1-15).ConclusionThe construction of negative pressure environments and development of a COVID-19 biocontainment protocol have helped to mitigate the impact of the pandemic on our patients and to maximize efforts in protecting our staff.