Anupriya Dayal, MD, radiation oncologist at Temple Health-Fox Chase Cancer Center and Pennsylvania delegate, American Medical Association Resident and Fellow Section House of Delegates, contributed this post. Opinions are the author’s own.
The impacts of COVID-19 on the field of radiation oncology are ever evolving. We face unique opportunities – and challenges – as we work to prioritize safe and quality patient care while we navigate this pandemic.
At the start of the pandemic, most non-emergent healthcare was halted, including cancer screening. Unfortunately, cancer incidence does not stop with the pandemic. For some patients, decreased screening now will delay diagnosis and/or increase cancer burden and worsen outcomes.
Having cancer care and/or end of life care discussions is already difficult for cancer patients and providers. Sometimes patients may feel like they have to make an impossible choice– whether they would like to risk their cancer becoming incurable by delaying treatment or whether they would like to risk contracting COVID-19 by leaving the security of their home to obtain treatment. As radiation oncologists, we continue assisting cancer patients in these difficult conversations.
For other patients receiving daily radiation treatment for cancer, we’re the only healthcare providers they may be seeing on a daily basis, especially if their primary care practitioner has limited services available due to the pandemic. We may have to step up to help the patient in the interim for their non-radiation oncology medical needs as well until they are able to seek treatment from their primary care provider.
Patients who don’t require in-person treatment, however, may seek care through telemedicine. In the field of radiation oncology, telemedicine may make it easier for patients to seek second opinions, and removes challenges such as transportation, scheduling or other conflicts that can arise with arranging in-person care.
Telemedicine also has unique limitations. Patients may appear healthy and functional on a telephone or video conference, but may not be doing nearly as well in person. Another unique example concerns anatomy. What appears on 2D video examination may be very different in person, so previously prepared simulation or treatment plans might have to change when the patient arrives for the first time in the department. However, these scenarios can be addressed with proper planning and flexibility.
Radiation oncologists in hotspots around the country are adjusting to a new normal, as many are being called to the frontlines alongside internists, surgeons, physician assistants, respiratory therapists and others, according to a recent blog from the American Society for Radiation Oncology. Radiation oncologists are researching new ways to identify the characteristic COVID-19 pneumonia concerns on CT Simulation scans (otherwise used for radiation treatment planning) and daily cone beam CT scans (otherwise used for daily set up alignment).[1] Further, radiation oncologists are also investigating the use of low dose lung radiotherapy to treat some COVID-19 patients.
While these times are challenging, the field of radiation oncology is responding to the call and adjusting our course as necessary to provide the best care for our patients.
- How does your facility approach care in the era of COVID-19? How can radiation oncologists continue to improve the safety and quality of patient care? Please share your thoughts in the comments section below, and join the discussion on Engage (login required).
[1] The American College of Radiology (ACR), Centers for Disease Control and Prevention (CDC), Canadian Society of Thoracic Radiology, Canadian Association of Radiologists, Royal Australian and New Zealand College of Radiologists and the (UK) Royal College of Radiologists currently recommend against use of computed tomography (CT) to diagnose COVID-19.
