Reports of Practical Oncology and Radiotherapy 25 (2020) 820–827 Available online at www.sciencedirect.com Reports of Practical Oncology and Radiotherapy jou rnal homepage: http://www.elsevier.com/locate/rpor Original research article Impact of COVID-19 on the performance of a radiation oncology department at a major comprehensive cancer centre in Poland during the first ten weeks of the epidemic a,b,∗ c d e f J Malicki , P Martenka , A Dyzmann-Sroka , K Paczkowska , E Leporowska , a,g h i j a,k W Suchorska , K Lamperska , P Pienkowski´ , A Chicheł , M Mocydlarz-Adamcewicz , l m n a,m o a,p a,m D Urbaniak , T Bajon , Z Cybulski , B Bak˛ , A Machtyl , K Adamska , J Kazmierska´ a,o r,s , P Milecki , A Marszałek a Electroradiology Department, Poznan University of Medical Sciences, Poznan,´ Poland b Medical Physics Department, Greater Poland Cancer Centre, Poznan,´ Poland c IV Radiotherapy Department, Greater Poland Cancer Centre, Piła, Poland d Epidemiology and Prophylactics Department, Greater Poland Cancer Centre, Poznan,´ Poland e Section for Coordination of Work of Interdisciplinary Teams, Greater Poland Cancer Centre, Poznan,´ Poland f Department of Laboratory Diagnostics, Greater Poland Cancer Centre, Poznan,´ Poland g Radiobiology Lab, Greater Poland Cancer Centre, Poznan,´ Poland h Department of Cancer Immunology, Greater Poland Cancer Centre, Poznan,´ Poland i Department of Head and Neck Surgery, Greater Poland Cancer Centre, Poznan,´ Poland j Brachytherapy Department, Greater Poland Cancer Centre, Poznan,´ Poland k IT Department, Greater Poland Cancer Centre, Poznan,´ Poland l Epidemiological Inspector, Greater Poland Cancer Centre, Poznan,´ Poland m II Radiotherapy Department, Greater Poland Cancer Centre, Poznan,´ Poland n Department of Microbiology, Greater Poland Cancer Centre, Poznan,´ Poland o Radiotherapy Department, Greater Poland Cancer Centre, Poznan,´ Poland p III Radiotherapy Department, Greater Poland Cancer Centre, Poznan,´ Poland r Department of Tumor Pathology and Prophylaxis, Poznan University of Medical Sciences, Poznan´ Poland s Department of Oncologic Pathology, Greater Poland Cancer Centre, Poznan, Poland a r t i c l e i n f o a b s t r a c t Article history: The outbreak of SARS-CoV-2 coronavirus rapidly altered radiotherapy service delivery around the world. Received 16 July 2020 Aim: The main objective of this study was to assess the impact of precautionary measures implemented Accepted 6 August 2020 in response to the COVID-19 pandemic on the performance of a radiation oncology departments and on Available online 16 August 2020 mitigation the risk of COVID-19 contagion between and among patients and staff. Methods: The study period was from March 15 until May 22, 2020. We evaluated total number of patients Keywords: irradiated and those who initiated treatments, taking into account tumours localisations. We assessed Radiotherapy the relationship of potential risk of contagion with patients’ domiciles locations in regions with high COVID19 qPCR number of COVID19 case. Antibodies Results and conclusions: The number of patients treated with radiotherapy during the study period Cancer incidence decreased due to precautionary measures. After five weeks, the number of radiotherapy treatments began to increase. Just over half of the radiotherapy patients (53.5%) treated at the GPCC reside in the city of Poznan or in one of the ten surrounding counties where COVID19 incidence was low and reached at the end of the study period cumulative number of cases n = 204. The precautionary measures were effec- tive qRT-PCR tests were performed in 1545 individuals (patients and hospital staff) revealing four staff members and none patient with a positive PCR result. Immunoglobulin testing was performed in 1132 individuals (patients and hospital staff). A total of 63 individuals were positive for antibodies. © 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved. ∗ Corresponding author at: 15 Garbary Street, Greater Poland Cancer Centre, Poland. https://doi.org/10.1016/j.rpor.2020.08.001 1507-1367/© 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved. J. Malicki et al. / Reports of Practical Oncology and Radiotherapy 25 (2020) 820–827 821 1. Introduction using MagCore Viral Nucleic Acid Extraction Kit (RBC Bioscience, Taiwan). RT-PCR was performed using the qPCR SARS-CoV-2 kit The outbreak of SARS-CoV-2 coronavirus disease started in 2019 (Vitassay Healthcare S.L.U, Spain) and the CFX96 Touch Real-Time (COVID-19) has and rapidly altered radiotherapy service delivery PCR Detection System (Bio-Rad, CA). 1–5 around the world. However, the specific precautionary mea- Anti-SARS-CoV-2 antibodies, such as immunoglobulin M and suares implemented at cancer centres and radiation oncology G (IgM and IgG) antibodies in serum were determined using the departments have varied widely depending on local factors and COVID-19 Rapid Test Kit (Biopanda Reagents Ltd. Belfast, United 6–8 situation. An important factor influencing the measures imple- Kingdom) and 2019-nCoV IgG/IgM Detection Kit (Nanjing Vazyme mented is the incidence of COVID-19 in the area where patients Medical Technology Co., Ltd. Nanjing, China). These tests used qual- 9–11 and hospital staff live. itative immunochromatography methods for the detection of IgM In response to the COVID-19 pandemic, in March 2020 the gov- and IgG antibodies to SARS-CoV-2. ernment of Poland implemented a series of measures designed to limit public activities (https://koronawirusunas.pl/; accessed from 3. Results 8th of March. The specific measures are shown in Table 1 by date of implementation. 3.1. Treatment of patients The restrictions related to COVID-19 have affected many aspects of daily life. Health care system was also influenced. Due to the For the reason of assessing the potential risk of contagion risk of widespread contagion and the restrictions imposed by by patients’ domiciles locations in regions with high number of the state of epidemic, treatment for medical conditions unrelated COVID19 case, we used outcomes for a year of 2013 from the to COVID-19 has been severely affected, including radiotherapy 12 study performed by Paczkowska. The population of the city for cancer patients. Although radiotherapy can be conditionally of Poznan in 2013 was 549,082. The county of Poznan, which interrupted or postponed in some patients, However, in most includes the city, had in 2013, 348,730 inhabitants. (as of June 30, cases uninterrupted radiotherapy is essential for optimal treatment 2013; http://demografia.stat.gov.pl/bazademografia/Tables.aspx). effects. However, during the pandemic status, radiation oncology The GPCC employs approximately 1200 people, most of whom live departments worldwide have been forced to implement numerous in the city of Poznan itself or within the county. prophylactic and precautionary measures. To our knowledge, the Just over half of the radiotherapy patients (53.5%) treated at the impact of these precautionary measures on radiation therapy for GPCC reside in the city of Poznan or in one of the ten surrounding patients with cancer in Poland has not been assessed, till now. counties (Fig. 1). The most populous regions in the hospital’s coverage area are 1.1. Aim the city and county of Poznan, where more than one-third of radio- therapy patients (35.3%) reside, according to data from a study The main objective of this study was to assess the impact of conducted in 2013.12 We used these data for the patients in the precautionary measures implemented in response to the COVID-19 study period (March 15 to May 22, 2020). Note that the percent- pandemic on the performance of a radiation oncology departments age of oncology patients treated with radiotherapy at the GPCC in given cancer centre in Poland. Secondly, we describe the mea- with domiciles in the city and county of Poznan was 33.6% lower sures introduced to reduce the risk of COVID-19 contagion between than for whole Poznan subregion (grouping all 11 counties) and and among patients and staff. lower than the figure (52%) calculated for Poland in the ESTRO- 13,14 HERO study. The geographic origin (i.e., place of residence) of patients treated with radiotherapy at the GPCC is shown in 2. Material and methods Table 2. * Cities of Poznan, Kalisz, Konin and Leszno form separate This observational study was performed to assess the impact administrative districts, while the area around these cities fall into of the COVID-19 epidemic—specifically, the precautionary mea- separate land districts even though they have the same name as the sures implemented at our centre (Greater Poland Cancer Centre; cities. GPCC)—on the clinical practice of radiation oncology at our centre. Table 3 shows the number of new patients initiating radio- To assess the impact of these measures, we determined the number therapy and the number of patients receiving daily radiotherapy of patients treated with radiotherapy during the 10-week period treatment in Poznan and at the two satellite sites in Kalisz and from March 15 to May 22, 2020 at the peak of the pandemic restric- Pila. Poznan is equipped with five linear accelerators, a Tomother- tions and compared these to the usual number of patients treated apy and a Cyberknife unit, while Kalisz and Pila possess two linear prior to the pandemic. We also sought to correlate the place of res- accelerators each. idence of both patients and staff with the severity of the epidemic As Table 3 shows, during the study period, fewer new patients (i.e., the incidence rate) in that region. were treated at our centre compared to the weekly average for To mitigate the risk of disease spread to or among staff and 2019. Similarly, the mean number of patient receiving daily treat- patients, the GPCC and the radiation oncology department intro- ment prior to the epidemic was 301, declining progressively until duced a series of precautionary measures.