The impact of COVID-19 on Brachytherapy Workflow: a two-centre experience

PURPOSE: The COVID pandemic has impacted radiotherapy (RT) workflow, including brachytherapy (BT). BT is an integral part of RT, many BT procedures require the support of general anesthesia and are considered aerosol generating medical procedures (AGMPs). During COVID pandemic, AGMPs required additional infection control precautions. This work summarized the impact of the COVID-19 pandemic on the BT program in two distinct cancer centres, located in Ontario, Canada. METHODS: The study period was March 1 to July 31, 2020, the ‘first wave’ of pandemic. The two centres are 73 km apart and located in a city with population of 2.79 million (Centre 1) and 0.7 million (Centre 2) respectively. BT services offered by these centres were high-dose-rate (HDR) treatments to post-operative endometrial cancers (Centre 1&2), cervix cancer (Centre 1), prostate cancer (Centre 1), lung cancer (Centre 2), esophagus cancer (Centre 2) and low-dose-rate (LDR) treatments to prostate cancer (Centre 1) and ocular cancer (Centre 1). A retrospective program audit was conducted as part of a quality assurance project. Data sources were identified by the BT Clinical Specialist Radiation Therapist (CSRT) in each centre using the radiation therapy electronic medical records (RT-EMR) system, electronic medical records and departmental reports, policies and procedures. RESULTS: COVID impact on BT services and workflow were recorded. BT SERVICES: Both centres continued to treat non-AGMP for post-operative endometrial cancer patients. However, BT services for AGMP procedures were on hold: LDR and HDR prostate treatments (Centre 1), HDR lung and esophagus treatments (Centre 2). The lung and esophagus cancer patient group had the most impact as patient were offered non-BT treatments for symptoms relieve. WORKFLOW: both centres implemented virtual care strategies for review and follow up appointments where telephone consultation were used. Both centres had a ‘no visitor’ policy in their hospital. Both centres adopted a “size and treat” strategy for non-AGMP HDR treatment to the vaginal vault. The strategy was implemented to eliminate one hospital visit required by post-operative endometrial cancer patients. Both centres used appropriate personal protective equipment (PPE) to reduce occupational exposure to staff. For AGMP (Centre 1), there is a change in anesthesia workflow where only anesthesia staff remained in the BT procedure room with doors closed during intubation and extubation. At the end of the procedure, the doors were closed for 30 minutes to allow sufficient room air exchange. Centre 1 and 2 had differences in asymptomatic COVID screening & test requirement for AGMP and non-AMGP. CONCLUSION: The centres were marginally different in their approaches to adjusting their BT workflows in AGMP and non-AGMP procedures. BT treatments that are considered high-risk AGMP and low-risk cancer were on hold temporarily. Both BT program delivered treatment to most patients with minimal delays and cancellations.