Prioritizing Delivery of Cancer Treatment During a COVID-19 Lockdown: The Experience of a Clinical Oncology Service in India

Abstract

Purpose: A COVID-19 lockdown in India posed significant challenges to the continuation of radiotherapy (RT) and systemic therapy services. Although several COVID-19 service guidelines have been promulgated, implementation data are yet unavailable. We performed a comprehensive audit of the implementation of services in a clinical oncology department.

Methods: A departmental protocol of priority-based treatment guidance was developed, and a departmental staff rotation policy was implemented. Data were collected for the period of lockdown on outpatient visits, starting, and delivery of RT and systemic therapy. Adherence to protocol was audited, and factors affecting change from pre-COVID standards analyzed by multivariate logistic regression.

Results: Outpatient consults dropped by 58%. Planned RT starts were implemented in 90%, 100%, 92%, 90%, and 75% of priority level 1-5 patients. Although 17% had a deferred start, the median time to start of adjuvant RT and overall treatment times were maintained. Concurrent chemotherapy was administered in 89% of those eligible. Systemic therapy was administered to 84.5% of planned patients. However, 33% and 57% of curative and palliative patients had modifications in cycle duration or deferrals. The patient's inability to come was the most common reason for RT or ST deviation. Factors independently associated with a change from pre-COVID practice was priority-level allocation for RT and age and palliative intent for systemic therapy.

Conclusion: Despite significant access limitations, a planned priority-based system of delivery of treatment could be implemented.

FIG 1

The change in case load in the outpatient clinics in the period corresponding to the first, second, and third phases of the lockdown (weeks 13-15, 16-18, and 19-20) for major cancer site groups.

FIG 2

The odds ratio and 95% CIs of the estimate for each variable obtained from logistic regression for radiotherapy (panel A) and chemotherapy (panel B) protocol deviations. The indicator value is toward the right of the colon sign. The x-axis of the plot is trimmed at 5.0. Age was modeled as a continuous factor, and therefore, interquartile range effects have been presented.