Evaluation of Patient and Staff Safety Through Continuous Delivery of Radiation Therapy During COVID-19 Pandemic

PURPOSE/OBJECTIVE(S): The current COVID-19 (COVID) pandemic has presented many challenges to the treatment of cancer patients. Radiation therapy departments were forced to create new operational workflows that permitted the monitoring of patient's COVID status during continued treatment; while simultaneously protecting the oncology care team. Radiation therapy planning process involves a very complex hand-off workflow between highly skilled care team professionals. The time between initiation of planning and first treatment is critical for optimal treatment outcomes. Insertion of pre-screening of COVID status prior to initiation of therapy could have considerable impact on the overall time between the initiation of planning and initiation of treatment. Our department CT SIM to treatment time average the four months prior to COVID was 8.9 days. Our study aimed to evaluate the effectiveness of our departmental COVID screening process and its effect on the safe delivery of radiation therapy. Further, we investigated if the insertion of a COVID screening process would have a negative impact on the total time to start. MATERIALS/METHODS: Operational workflow changes were set in place to pre-screen all patients prior to the initiation of radiation therapy. Patients presenting with COVID symptoms after initial clearance, were subjected to additional round of COVID testing. These patients were placed in the sequestered protocol until cleared. UT Health San Antonio School of Nursing, with the help of grant supplied by Hyundai, provided COVID testing for all our patients. Quality assurance tracking mechanisms were put into place to track COVID testing and results. COVID positive patients were treated in a clinically sequestered protocol. Positive results were subjected to contact tracing. RESULTS: Data were collected from April 1, 2020 to December 31, 2020. During this time period, a total of 684 patients underwent COVID testing. A total of 679 patients tested negative. Five patients identified as COVID positive. A total of 18 sequestered radiation treatments were delivered. During the study timeframe a total of 4 care team members tested positive for COVID. All patient and care team contact tracing indicated source of infection was encountered outside of the treatment setting. Average time from initiation of CT simulation order to the resulting of COVID testing was 7.08 days. Average simulation to initiation of treatment during this time period was a total time was 7.7 days an improvement of 1.2 days. CONCLUSION: With appropriate protocols and team vigilance; continued delivery of radiation therapy to cancer patients can be achieved. These protocols did not affect the overall time to initiate treatment. Due to more frequent observation of status and a streamlining of process the team was able to reduce cycle time from simulation to initiation of treatment from 8.9 to 7.7 days.