Advances in Radiation Oncology Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil --Manuscript Draft-- Manuscript Number: ADVANCESRADONC-D-20-00407R3 Article Type: Scientific Article Section/Category: COVID-19 Corresponding Author: Harley Francisco de Oliveira, PhD Centro de Tratamento em Radio-Oncologia (CTR) and Fundação São Francisco Xavier (FSFX) - Hospital Márcio Cunha Ribeirão Preto, São Paulo BRAZIL First Author: Harley Francisco de Oliveira, PhD Order of Authors: Harley Francisco de Oliveira, PhD Gerson Hiroshi Yoshinari Jr, PhD Igor Moreira Veras, MD Wilson José de Almeida Jr, MD Nilceana Maya Aires Freitas, PhD Marcus Simões Castilho, MD Antônio Cassio de Assis Pellizzon, PhD Felipe Erlich, MD Renato José Affonso Jr, PhD Ícaro Thiago de Carvalho, MD André Campana Correia-Leite, MD Felipe Quintino Kuhnen, MD Rosa Maria Xavier Faria Najas, MD Arthur Accioly Rosa, MD Abstract: Purpose : The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. Methods and Materials: The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. Results: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions and other changes in daily practice. Conclusions: Thus, there was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic. Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation Title Page (WITH Author Details) Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil Impact of COVID-19 on Brazilian Radiotherapy Harley F. Oliveira, PhD a*; Gerson H. Yoshinari Jr, PhD b; Igor M. Veras, MD c; Wilson J. de Almeida Jr, MD d; Nilceana M. A. Freitas, PhD e; Marcus S. Castilho, MD f; Antônio C. de A. Pellizzon, PhD g; Felipe Erlich, MD h; Renato J. Affonso Jr, MD i; Ícaro T. de Carvalho, MD j; André C. C. Leite, MD k; Felipe Q. Kuhnen, MD l; Rosa M. X. F. Najas, MD m; Arthur Accioly Rosa, MD n a. Radiotherapy Department of the Centro de Tratamento em Radio-Oncologia (CTR), Ribeirão Preto/SP; Márcio Cunha Hospital – Fundação São Francisco Xavier, Ipatinga/MG – Brazil. b. Faculty of Medicine of Itajuba – Afya group, Itajubá/MG; Radiotherapy Department of the Oncominas, Pouso Alegre/MG – Brazil. c. Radiotherapy Department of the Regional Integrated Oncology Center, Fortaleza/CE – Brazil. d. Radiotherapy Department of the Moinhos dos Ventos Hospital, Porto Alegre/RS – Brazil. e. Radiotherapy Department of the Araújo Jorge Hospital of the Góias State Association Against Cancer, Goiânia/GO – Brazil. f. Radiotherapy Department of the Felicio Rocho Hospital, Belo Horizonte/MG – Brazil. g. Radiotherapy Department of the AC Camargo Hospital, São Paulo/SP – Brazil. h. Radiotherapy Department of the José Alencar Gomes da Silva National Cancer Institute (INCA), Rio de Janeiro/RJ – Brazil. i. Radiotherapy Department of the Barretos Cancer Hospital, Barretos/SP – Brazil. j. Radiotherapy Department of the Albert Einstein Hospital, São Paulo/SP – Brazil. k. Radiotherapy Department of the Dom Pedro de Alcantara Hospital, Feira de Santana/BA – Brazil. l. Radiotherapy Department of the Charity Hospital of Florianópolis, Florianópolis/SC – Brazil. m. Radiotherapy Department of the Rio Grande do Norte State League Against Cancer, Natal/RN – Brazil. n. Radiotherapy Department of the Santa Izabel Hospital and Português da Bahia Hospital, Salvador/BA; Director of Radiotherapy Oncoclinicas Group; President of the Brazilian Radiotherapy Society (SBRT), São Paulo/SP – Brazil. Corresponding Author: Harley Francisco de Oliveira, PhD; e-mail: [email protected] Author Responsible for Statistical Analysis: Gerson Hiroshi Yoshinari Júnior, PhD; e-mail: [email protected] Disclosures: none. Sources of support: This work had no specific funding. Research data are available at: www.sbradioterapia.com.br Acknowledgements: The Brazilian Radiotherapy Society (SBRT) thanks to the Brazilian radiation oncology departments for keeping the radiotherapy to the patients during the COVID-19 pandemic. Summary Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil The Brazilian Radiotherapy Society (SBRT) developed a questionnaire for estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments (RO). These data were evaluated regarding cases confirmed and deaths by COVID-19 on July 11, 2020. 126 questionnaires were answered (44% of the RO). A drop in the number of patients was observed in 61% of RO, being observed both in patients from the public and supplementary private health insurance systems. BLINDED Revised Manuscript (Unmarked) Impact of the COVID-19 pandemic on Radiation Oncology Departments in Brazil Abstract: Purpose: The COVID-19 pandemic brought several challenges to cancer practice, especially to ensure continuity of treatment during this period, minimizing the risks of transmission to a vulnerable population. For Radiation Oncology departments in Brazil, this contingency has become even more complex due to the significant impact observed in different sectors of society, the large number of cases and deaths by COVID-19. This study estimated the impact of the COVID-19 pandemic on Brazilian Radiation Oncology departments and the coping measures used in the country. Methods and Materials: The Brazilian Radiotherapy Society (SBRT) developed a questionnaire with 14 questions, sent to all heads of Radiation Oncology departments in the country, between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiological week 28, on July 11, 2020. Results: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country’s services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observe that services that primarily treat SUS patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiotherapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness, distance, restrictions on access to companions and other changes in daily practice. Conclusions: Thus, there was an important drop in the number of radiotherapy patients in the country during the pandemic, and this impact happened in a similar way among the services, regardless of their characteristics and coping measures adopted during the pandemic. Introduction: The COVID-19 pandemic declared by the World Health Organization (WHO), given the growing incidence and the complex repercussion observed in different social environments worldwide, requires comprehensive care for the population, especially those with associated comorbidities 1. In this context, patients diagnosed with cancer have a higher risk of severe infections and mortality, especially during cancer treatment, in which they are in vulnerable conditions. The COVID-19 and Cancer Consortium (CCC19) 2 and Thoracic Cancers International COVID-19 Collaboration (TERAVOLT) 3 ran studies with COVID-19 patients. They identified that patients with advanced age, male gender, impaired functional status, and associated comorbidities, such as hypertension, chronic lung disease, diabetes, and active cancer under treatment have a higher risk of morbidity and mortality 2–5. To minimize the impact of the intense demand caused by the increase in the number of contaminants in the country, above its installed capacities, several contingency measures for health services have been proposed in order to guarantee access to patients with severe acute respiratory syndrome (SARS) caused by the new Coronavirus (SARS-CoV-2). Thus, medical care considered elective and those procedures of less complexity and low risk of aggravation were suspended in almost all health services in Brazil. However, even patients with a high suspicion of cancer had delayed