Reducing the Impact of COVID-19 on Radiation Oncology Units of Developing Countries: A Rapid Review and Expert Consensus

In this work, we present recommendations to countries with limited health resources for management decisions in radiotherapy units during the pandemic for COVID-19. This effort aims to reduce the impact of the COVID-19 pandemic on the delivery of radiotherapy treatments. In countries like Ecuador, the access to radiotherapy for cancer patients is limited and this pandemic has aggravated this situation. In this context, we develop recommendations for the management of radiotherapy services with the objective of guaranteeing that high-quality treatments continue to be delivered despite the health crisis caused by the COVID-19.

The recommendations aim to establish specific parameters where treatments can be omitted, deferred, prioritized and shortened following the framework initially proposed for prostate cancer: RADS (Remote visits, and Avoidance, Deferment, and Shortening of radiotherapy). We applied this approach to other pathologies besides urologic cancers as gynecological tumors, breast cancer, gastrointestinal tumors, skin cancer, tumors of the central nervous system, and lymphomas. An expert group discussed online the extracted data and drafted the recommendations considering the lack of personnel and equipment in Ecuadorian radiotherapy units and that the capacity of the national health system will be exceeded.

Treatment schemes are recommended for each pathology, prioritizing hypo-fractionated schemes when possible. We additionally present recommendations to mitigate virus transmission in radiotherapy units.

Written by: Nadia Montero Oleas, MD, Postgraduate Radiotherapy, Faculty of Medical Sciences, Central University of Ecuador, Quito, Ecuador, Twitter: @NadiaMontero7

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