Novel coronavirus mitigation measures implemented by radiotherapy centres in low and middle-income countries: a systematic review

Abstract

Aim: To identify strategies adopted by radiotherapy centres in low and middle-income countries (LMICs) to mitigate the effects of COVID-19.Background: Studies summarising COVID-19 mitigation strategies designed and implemented by radiotherapy centres in LMICs to avoid delays, deferrments and interruptions of radiotherapy services are lacking.Materials and Methods: A systematic review was conducted and reported in accordance with the preferred reporting items for systematic review and meta-analysis guideline. Ovid Embase, Ovid MEDLINE and CINAHL were searched for peer-reviewed articles that reported measures adopted by radiotherapy centres in LMICs to reduce the risk of COVID-19. Information on different strategies were extracted from the included studies and textual narrative synthesis was conducted.Results: Of the 60 articles retrieved, eleven were included. Majority of the studies were conducted in China. Ten of the included studies employed a qualitative design. Four themes were identified: preparing and equipping staff; reinforcing infection prevention and control policies; strengthening coordination and communication; and maintaining physical distancing. Studies reported that radiotherapy centres have: formed COVID-19 response multidisciplinary team; maximised the use of telehealth; adjusted the layout of waiting areas; divided staff into teams; dedicated a room for isolating suspected cases; and adopted triage systems.Conclusions: Local adaptation of established global strategies coupled with timely development of guidelines, flexibility and innovation have allowed radiotherapy leaders to continue to deliver radiotherapy services to cancer patients in LMICs during the COVID-19 crisis. Robust and quality data collection must be encouraged in LMICs to provide an evidence-based knowledge for use in the event of another pandemic.

The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning

“…Our findings highlight prior knowledge to indicate that radiography practice varies widely across different settings and among countries, often due to differences in both expert human and physical resource availability. 8 , 34 , 35 , 36 , 37 , 61 , 74 As medical imaging has played an important role in both the diagnosis and management of COVID-19 patients, the pandemic has highlighted existing global discrepancies in radiography resource availability. 35 , 37 , 61 , 74 The findings suggest that the knowledge-base of radiographers about the pandemic has improved over time.…”

“… 8 , 34 , 35 , 36 , 37 , 61 , 74 As medical imaging has played an important role in both the diagnosis and management of COVID-19 patients, the pandemic has highlighted existing global discrepancies in radiography resource availability. 35 , 37 , 61 , 74 The findings suggest that the knowledge-base of radiographers about the pandemic has improved over time. For example, Kotian and colleagues 11 reported relatively low knowledge of COVID-19 among India's radiography workforce at the initial stages of the pandemic (March, 2020), similar to the baseline findings reported among their Irish counterparts at approximately the same period of the pandemic.…”

“…Of note, these new clinical initiatives including the use of information technologies to enhance remote working in clinical radiotherapy follow-up consultations and planning are not universal. 8 , 12 , 13 , 21 , 34 , 42 , 61 , 62 , 75 , 77 , 78 Further highlighting the need for adaptation of established global strategies for use within local settings.…”

“… 30 , 31 , 32 , 33 , 60 In line with these recommendations, radiotherapy departments underwent resource and technical re-organisation to allow the continuation of daily cancer care provision. 23 , 24 , 25 , 26 , 27 , 28 , 34 , 61 , 62 The recommendations included the implementation of strict hygiene protocols to guarantee the safety of cancer patients, many of whom are generally immunocompromised and at increased risk of COVID-19 complications, and of staff administering the treatments. Additionally, strict triage systems and the use of hypofractionation protocols designed for specific cancers were rapidly implemented 30 , 31 , 32 , 33 to allow cancer care continuation during the pandemic.…”