ONCOLOGY IN THE FACE OF AN EPIDEMIC

When all forces and resources in the health service are directed to fighting the epidemic, oncology must remain able to operate efficiently so that cancer patients continue to be treated. Every day, approximately 170 patients undergo radiotherapy at the Amethyst Radiotherapy Center and the Rydygier Hospital in Krakow. Marcin Hetnał, MD, medical director of Amethyst and head of the radiotherapy department, talks about the challenges associated with this.

Patient associations and many oncologists are alarming that the number of oncological patients has decreased, diagnostics are poor, and fewer DiLO (Diagnostics and Oncological Treatment) cards are issued. However, your facility does not see any reduction in traffic.

Marcin Hetnał: In September, over 300 patients completed our therapy. 290 in October. We work very intensively. However, I also have to confirm the facts you mentioned. We recorded a clear decline in the number of patients in April and May, which was an obvious result of the suspension of the functioning of many medical facilities and the fear of patients about the coronavirus. However, oncology patients are aware of their condition, so after the first shock, most of them returned to therapy. Hence our current statistics. However, we look to the future with concern, because the current increases in Covid-19 cases may again affect the effectiveness of oncological treatment. Problems with diagnostics, closed hospital wards, imperfect teleconsultations in clinics, postponed dates of planned procedures, staff shortages, and patient anxiety will soon result in another decline in oncology patients undergoing therapy.

Delaying treatment for cancer can have devastating consequences.

MH: Delaying the start of treatment increases the risk of death by up to several percent. It also increases the length and burden of therapy. In the case of rapidly growing tumors, including: located around the head and neck, lungs and cervix, every day counts. For these reasons, p

Has Covid-19 had any impact on the therapies used? How do you heal today?

MH: Radiotherapy has not changed, but we now approach treatment time differently and prioritize it differently. First of all, we focus on shorter fractionation schemes enabling the delivery of the appropriate dose of radiation in a shorter time. This increases the safety of the patient, who stays in a medical facility for a shorter time and moves less, so the possibility of infection is minimized. For example, in the case of breast cancer, we now usually use 3-week regimens instead of 5 weeks. In some situations, we choose to postpone the invasive procedure (this applies to brachytherapy, when the radiation source is placed in the tumor or its vicinity), changing the order of therapeutic methods used. This may apply, for example, to low-risk prostate cancer patients. All these modifications are consistent with applicable medical procedures and are safe for patients. The coronavirus epidemic forced us to be even more flexible and led to even more individualized treatment. We consider each case separately.

The epidemic caused the spread of teleconsultations in medicine. How effective is this method in oncology?

MH: Already in March, we replaced some traditional follow-up visits with telephone consultations. They are a great convenience for patients who do not have to travel by public transport, contact other people, and can maintain a safe social distance. However, after nearly nine months of experience, we also know that teleconsultations in oncology may constitute only a fraction of our contacts with patients. The first visit and control before starting therapy absolutely require direct contact. During radiotherapy, in many cases of cancer, the doctor also needs to see the patient. However, teleconsultations work well as follow-up visits for patients after radical treatment.

What happens when an oncology patient gets sick with covid-19?

MH: Like any other person, he or she must self-quarantine and be under medical supervision if symptoms occur. From a radiotherapy perspective, this is a difficult moment because in many cases it requires interruption of treatment. This has happened to us several times since the outbreak of the epidemic. After the disease ends, we resume radiotherapy. We are already treating several recoveries in our center. However, there are asymptomatic cases in which it is necessary to continue treatment of the cancer due to its rapid growth. We are ready for this eventuality. These months of fighting the epidemic meant that we learned to live with it. Both our medical staff and patients are accustomed to the sanitary regime. We are aware that any of us can get sick, which is why we use all necessary safeguards and skillfully rotate our staff. So far, these methods have proven effective. We are healing all the time.