Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer.

PURPOSE: We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. METHODS: Patients completed a survey 1 month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. RESULTS: Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). CONCLUSION: Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.

Exploring the Perceived Educational Impact of COVID-19 on Postgraduate Training in Oncology.

This study sought to report the degree to which postgraduate trainees in radiation oncology perceive their education has been impacted by the COVID-19 pandemic. A cross-sectional online survey was administered from June to July 2020 to trainee members of the Canadian Association of Radiation Oncology (CARO) (n = 203). Thirty-four trainees responded with a 17% response rate. Just under half of participants indicated that COVID-19 had a negative/very negative impact on training (n = 15; 46%). The majority agreed/strongly agreed that they feared family/loved ones would contract COVID-19 (n = 29, 88%), felt socially isolated from friends and family because of COVID-19 (n = 23, 70%), and had difficulty concentrating on tasks because of concerns about COVID-19 (n = 17, 52%). Changes that had a negative/very negative impact on learning included limitations to travel and networking (n = 31; 91%) and limited patient contact (n = 19; 58%). Virtual follow-ups (n = 25: 76%) and in-patient care activities (n = 12; 36%) increased. Electives were cancelled in province (n = 10; 30%), out-of-province (n = 16; 49%), and internationally (n = 15; 46%). Teaching from staff was moderately reduced to completely suppressed (n = 23, 70%) and teaching to medical students was moderately reduced to completely suppressed (n = 27, 82%). Significant changes to radiation oncology training were wrought by the pandemic, and roughly half of trainees perceive that these changes had a negative impact on training. Innovations in training delivery are needed to adapt to these new changes.

Radiation Oncology Virtual Education Rotation (ROVER) 2.0 for Residents: Implementation and Outcomes.

The COVID-19 pandemic catalyzed the integration of a virtual education curriculum to support radiation oncologists in training. We report outcomes from Radiation Oncology Virtual Education Rotation (ROVER) 2.0, a supplementary virtual educational curriculum created for radiation oncology residents globally. A prospective cohort of residents completed surveys before and after the live virtual webinar sessions (pre- and post-surveys, respectively). Live sessions were structured as complex gray-zone cases across various core disease sites. Resident demographics and responses were summarized using means, standard deviations, and proportions. Nine ROVER sessions were held from October 2020 to June 2021. A total of 1487 registered residents completed the pre-survey, of which 786 attended the live case discussion and 223 completed post-surveys. A total of 479 unique radiation oncology residents (of which 95, n = 19.8%, were international attendees) from 147 institutions (national, n = 81, 55.1%; international, n = 66, 44.9%) participated in the sessions. There was similar participation across post-graduate year (PGY) 2 through 5 (range n = 86 to n = 105). Of the 122 unique resident post-surveys, nearly all reported learning through the virtual structure as "very easy" or "easy" (97.5%, n = 119). A majority rated the ROVER 2.0 educational sessions to be "valuable or "very valuable" (99.2%, n = 121), and the panelists-attendee interaction as "appropriate" (97.5%, n = 119). Virtual live didactics aimed at radiation oncology residents are feasible. These results suggest that the adoption of the ROVER 2.0 curricula may help improve radiation oncology resident education.

Evaluating the Utility of Webinars Discussing the Radiation Oncology Residency Application Process in the COVID-19 Era

Background Since the start of the COVID-19 pandemic, the number of digital resources available for medical students (MS) interested in radiation oncology (RO) has increased. Here, we evaluated the utility of webinars focused on educating MS about the RO residency application process. Methods The American College of Radiation Oncology hosted webinars in 2021 and 2022 prior to the Electronic Residency Application Service (ERAS) application deadline. For each webinar, program directors gave short presentations about the ERAS application, interviews, and program ranking, and concluded with question and answer session. Participant demographics were collected using live poll questions and understanding was assessed using a Likert scale (range 1 [no, not at all] to 4 [yes, definitely]). Recordings were available online for asynchronous viewing. Differences between groups were assessed using Chi-square statistics. Results Between both webinars, there were a total of 69 participants and 170 asynchronous views. A total of 86% and 71% of participants answered the demographics and understanding questions, respectively. The majority attended medical school within the US (75%), were in their third/fourth year (70%), graduating with an M.D. degree (88%), and planned to apply to RO residency (78%). In terms of baseline knowledge of the application process, 49% believed they knew "a lot," while 51% believed they knew "a little" or "nothing." The majority of participants noted the webinar improved their understanding of the general application process (mean 3.80), the ERAS application (mean 3.65), and the interview process (mean 3.90). For a subset of participants (n=39), survey results were stratified by baseline understanding of the application process ("a little" versus "a lot"). Compared to participants who knew "a lot" about the application process, those that knew "a little" about the process reported higher scores in general understanding (mean 3.80 versus 3.60), ERAS application (mean 3.72 versus 3.50), and interview process (mean 3.93 versus 3.8). However, these differences were not statistically significant. Discussion As the number of digital resources in RO increases, we must examine whether they meet the needs of their target audience. Webinars can improve MS understanding of the RO residency application process. These webinars were an ideal format to educate MS about this process because they utilized both attending and resident physicians - two sources of information considered highly trustworthy by MS. Given the recent decline in applications to RO, engaging with MS through dedicated webinars warrants continued exploration.

Impact of COVID-19 pandemic on delivery of pediatric radiotherapy: A critical review.

The COVID-19 pandemic has prevented the timely diagnosis and treatment of many diseases, including pediatric cancer. Its impact on pediatric oncologic treatments warrants investigation. As radiotherapy is an integral component of cancer care, we reviewed the published data regarding the impact of COVID-19 on the delivery of pediatric radiotherapy to inform actions for future global events. We found that disruptions in radiotherapy were reported amongst interruptions in other therapies. Disruptions were more common in low-income countries (78%) and low middle-income countries (68%) compared with upper middle-income countries (46%) and high-income countries (10%). Several papers included recommendations for mitigation strategies. Altered treatment regimens were common, including increasing the use of active surveillance and systemic therapy to delay local therapies, and accelerated/hypofractionated dose delivery. Our findings suggest that COVID-19 has impacted radiotherapy delivery in the pediatric population globally. Countries with limited resources may be more affected. Various mitigation strategies have been developed. The efficacy of mitigation measures warrants further investigation.

Stereotactic Radiotherapy for the Treatment of Recurrent Refractory Vt in Chagas Disease Patients

Background: Stereotactic radiotherapy (SBRT) is a new therapeutic option for patients with scar related ventricular tachycardia (VT). Objective(s): To describe our experience with the use of SBRT for the treatment of recurrent VT in patients with Chagas Cardiomyopathy (CCM) in whom catheter ablation is not an option. Method(s): We selected patients with Chagas Disease that underwent SBRT for recurrent VT treatment. The target sites of SBRT were planned based on CMR and CT reconstruction on ADAS software, bipolar voltage maps from previous CA procedures and VT morphology induced on a electrophysiologic study performed SBRT planning. Target sites were decided together by electrophysiology and radiation oncology group. Result(s): We performed SBRT in six CCM patients July 2021 to July 2022. Most patients were male (66.7%), mean age 62.3+/-5.7 years-old and EF 28.5% (Q1: 20 Q3:42.7). One patient (16.7%) had two prior catheter ablation, four (66.7%) had one and one patient had no prior ablation, but had severe pulmonary fibrosis after COVID and was O2 dependent. The mean PTV (planning target volume) was 85+/-14 mL and the ITV (internal target volume) was 29+/-4 ml, with safe constraints regarding the esophagus and stomach. In a mean FU of 244+/-173days, 3 (50%) patients presented VT recurrence after blanking period. Two patients died 86 and 50 days after SBRT. The median number of VT episodes reduced from 13 (6.25;44.75) to 7.5 (3;7.5) (P = 0.093). All alive patients stop presenting VT in a median period of 174 (Q1: 44.75: Q3: 199) days, being at the end of the follow-up in a median of 196 (Q1: 137;Q3: 246) days without new VT episodes. Conclusion(s): SBRT presents a high rate of early recurrence in Chagas disease patients that improves during timeCopyright © 2023

Improving Interdepartmental Communication with Radiation Oncology

Topic significance and study purpose/background/rationale: The current Radiation Oncology electronic health record (EHR) at an Academic Medical Center remains distinct from the EHR in use by other departments. The transplant tracking system used by the Transplant and Cellular Therapy (TCT) division provides additional complexity. The previous system relied on treatment schemas physically signed by the attending, then scanned into the transplant tracking system. Precipitated by the COVID-19 pandemic, entering and verifying chemotherapy admissions moved from paper to the EHR. The transplant coordinator enters and routes the conditioning treatment plans to the physician and clinical pharmacists for verification. The clinical pharmacists integrated dosing into the treatment plans for conditioning regimens. Evaluation within the continuous quality improvement process identified that Radiation Oncology still utilized the transplant tracking system to plan total body irradiation (TBI) dose dates. The limited comfort and ability of Radiation Oncology to view treatment plans was identified as a barrier. To prevent errors, a standardized process to communication within the EHR was developed. Methods, intervention, and analysis: While the conditioning regimen information could be included in the referral order, Radiation Oncology wanted further documentation of physi-cian signatures, particularly to allow for plan alterations. To further document the physician signatures, a standardized note template was developed for the transplant coordinators to utilize in a nursing note. The note summarizes the condi-tioning regimen and radiation dates, then gets automatically routed to the attending physician for co-signature and, if necessary, attestation. Findings and interpretation: The project is ongoing with a goal compliance rate of 100% for adult stem cell recipients undergoing TBI-based conditioning. Discussion and implications: Workarounds open up vulnera-bilities for safety lapses, particularly within a complex health-care system. Utilization of the EHR's full capabilities provides an opportunity to clearly document communicationCopyright © 2023 American Society for Transplantation and Cellular Therapy

Research culture in Australian and New Zealand radiation oncology: Fact or fantasy?

INTRODUCTION: Fostering a research culture is a key goal of the Royal Australian and New Zealand College of Radiologists, yet there has never been an organization-wide enquiry into the extent to which this is being realized. The purpose of this work was to address that deficit for the Radiation Oncology (RO) Faculty to serve as a baseline for future comparison. The hypothesis was that such a culture is closer to fact than fantasy. METHODS: With College approval, three de-identified Excel spreadsheets detailing 25 research-related sub-categories of the Faculty's Continuing Professional Development (CPD) database were interrogated for the 2019-21 triennium, accepting that research activity in 2020-21 would be COVID-19 suppressed. The numbers obligated to self-report CPD were 482, 496 and 511, respectively. Primary endpoints were the percentages of ROs claiming at least one research-related activity overall, and in each of the sub-categories individually, by year. Secondary endpoints were the "breadth" (number of sub-categories claimed/individual) and "depth" (percentages solely claiming in one of four lower-level sub-categories), by year. RESULTS: ROs claimed in 23/25 sub-categories. The percentages of ROs claiming at least one research-related activity were 71%, 44%, and 62% in 2019-21, respectively. The median number of sub-categories claimed by these ROs was 2 (range 1-10) in each year. The commonest activity was journal article co-author (25%, 16% and 27%, respectively). For 2019, the most representative year, other common activities were inhouse/local meeting presentation (17%), invited lecture at state level or above (15%), manuscript peer review and research project principal investigator (14% each). The percentages of ROs solely claiming in one lower-level activity ranged between 4.4% and 5.9% per year. CONCLUSION: A culture of research is arguably more fact than fantasy in ANZ. It is likely that Faculty curriculum requirements, research funding and other promotional initiatives have contributed substantively to this.

How to Develop a Virtual Tour in Medical Physics

Purpose: For several years, virtual and blended-learning courses in Medical Physics are offered at the German Cancer Research Center (DKFZ) for national and international postgraduates, working in clinical or research institutes at the same time. While hosting such courses, we were able to gain a deeper understanding of multimedia learning for working professionals and their specific needs. Based on this long-lasting experience, we could transfer all courses into a full virtual mode since the start of the Covid-19 pandemic. However, visits to Heidelberg and our clinical institutes were and still are not possible. Therefore, participants are lacking this important experience. Material(s) and Method(s): To fulfil this gap, we decided to develop a first virtual tour about our division Medical Physics in Radiation Oncology, based on previous work of the Austrian authors (e.g. developing virtual labs for students). The idea is to evaluate the workload, technical challenges and possibilities that are available to us for future tours. As theoretical context we understand "multimedia learning" as "learning from words and pictures" (Mayer 2008, p. 761). Thus, it follows two channels: auditory/verbal and visual/pictorial. Both channels are limited and can only process a limited number of simultaneous processes (elaborated as Cognitive Load Theory by Sweller 2005). Main criteria derived from this framework are the basis for developing the tour layout (Mayer & Moreno 2003). To develop the tour we decided to use existing tools like our Moodle platform which includes the H5P plugin and allows us to design virtual tours based on 360-degree pictures. In addition to existing audio-video equipment, we purchased a simple 360-degree camera. Result(s): We are going to present the virtual tour and its layout and design, consisting of 360-degree pictures, text and videos offering an overview about our division at DKFZ. Conclusion(s): The tour is considered as template for tours to be developed in the future. More work about the application of didactical criteria and about the user's perspective is needed to integrate virtual tours in didactical settings. References: 1. Mayer, R. E., & Moreno, R. (2003). Nine ways to reduce cognitive load in multimedia learning. Educational Psychologist, 38(1), 43-52. 2. Mayer, R. E. (2008). Applying the Science of Learning: Evidence Based Principles for the Design of Multimedia Instruction. The American Psychologist, 63, 760-769. 3. Sweller, J. (2005). Implications of cognitive load theory for multimedia learning. In R. E. Mayer (Ed.), The Cambridge Handbook of Multimedia Learning (19-30). Cambridge [u.a.].Copyright © 2023 Southern Society for Clinical Investigation.

Breast Cancer-Related Lymphedema and its Relationship to Major Landmark Trials in Surgical Oncology and Radiation Oncology

INTRODUCTION: Many landmark trials have challenged the need for extensive axillary surgery and radiation in breast cancer patients. De-escalation of axillary treatment could potentially result in less breast cancer-related lymphedema (BCRL). Our study aims to define the incidence and trends of BRCL over the last 15 years. METHOD(S): Since 2005, our institution has prospectively screened breast cancer patients for lymphedema during and after treatment with a Perometer. 2,334 women diagnosed with breast cancer with baseline arm volume measurements and at least 2 follow-up measurements were divided into 3 cohorts based on date of surgery (Cohort 1: 2005-2010, Cohort 2:2011-2016, Cohort 3: 2016-2022). The cohorts were selected to coincide with publications of the landmark trials NSABP B-32, ASCOG Z0011, ASCOG Z1071, and EORTC 10981-22023 AMAROS which demonstrated safety in reducing the number of axillary lymph node dissections (ALND). Lymphedema was defined as a relative volume change of 10% or greater from preoperative baseline at least 3 months post-operatively. In cases of bilateral surgery, the weight-adjusted arm volume change equation was utilized. Cohort, age, BMI, axillary surgery type, chemotherapy timing, radiation type, and surgery type were all included in the multivariate analysis. RESULT(S): The overall incidence of BCRL was 12.8%, with a 29.6% incidence for those undergoing ALND and a 6.4% incidence for those undergoing sentinel lymph node biopsy. While the number of ALND performed decreased between cohorts (Figure 1), there was no significant difference in BCRL between assigned cohorts (HR 1.02 (95% CI [0.69, 1.51], p=0.930 for cohort 3 vs cohort 1). On multivariate analysis, significant associations with development of BCRL were identified with older age (HR 1.02;95% CI [1.01, 1.03], p=0.002), higher BMI (HR 1.05;95% CI [1.04, 1.07], p< 0.0001) and ALND (HR increased the risk of (HR 3.67;95% CI [2.62, 5.13], p< .0001). Regional lymph node radiation was not significantly associated with BCRL. CONCLUSION(S): Despite a reduction in the number of ALND performed over time, we did not see a dramatic reduction in the incidence of BCRL. Interestingly, between cohort 2 and cohort 3 there was a stable incidence of ALND which could be related to the COVID pandemic with an increase in more advanced cancers and a decrease in the ability to screen patients for BCRL during that time period.

Radiation Therapy amidst the COVID-19 Pandemic in the Philippines: When Guidelines are Not Enough

Background. To respond to the pandemic, many societies, including the American Society for Radiation Therapy (ASTRO), the United Kingdom's National Institute for Health and Care Excellence (NICE), and the Philippine Radiation Oncology Society (PROS), recommended guidelines to allow for continued safe delivery of oncologic services. Yet, the delivery of radiotherapy during the COVID-19 pandemic remains a challenge. Objective. To describe the situation of radiotherapy delivery in Metro Manila (NCR) during the COVID-19-related quarantine. Specifically, the objectives were to determine: (1) how the radiotherapy providers implemented the recommended changes, (2) if these implemented changes allowed the hospitals to operate with pre-COVID capacities, and (3) the causative factors of treatment interruptions if these were present. Additionally, in the face of treatment interruptions, the authors sought to put forth recommendations to decrease treatment interruptions. Methods. Investigators gathered data on the prevailing situation of RT services in their respective institutions during the strictest period of quarantine - Enhanced Community Quarantine (ECQ). Patients aged 18-70 years old who missed at least one fraction during the ECQ from March 16 - April 15, 2020, were invited to participate in a phone survey to determine factors contributing to treatment interruptions. Results. All the institutions implemented global recommendations to adapt to the pandemic, including infection control measures, telemedicine, and modification of RT plans. Despite this, most institutions had increased treatment interruptions during ECQ. The percentage of patients with interruptions was also much higher during the ECQ (66.37%) than during the pre-COVID month (30.56%). Among 142 patients unable to continue treatment, there were no significant differences in demographic variable and oncologic profile rates. The majority were more worried about getting COVID-19 than missing RT. The most common factor for treatment interruptions was transportation, followed by fear of getting COVID-19. Conclusion. Compliance with global recommendations is not enough to ensure that the patients who require radiotherapy will receive it. Based on institutional and patient results, the causative factors of interruptions included suspension of services, lack of transportation, and anxiety of patients and staff. Especially in low-resource settings, recommendations are to use available resources as efficiently as possible by having an organized referral system, providing transportation or nearby accommodation for patients and staff, and communicating effectively to reassure patients that radiotherapy can be continued safely. © 2023 University of the Philippines Manila. All rights reserved.

Overcoming Burnout and Promoting Wellness in Radiation Oncology: A Report From the ACR Commission on Radiation Oncology.

Burnout, defined by the presence of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, impacts a significant portion of radiation oncologists. This has been exacerbated by the COVID-19 pandemic, is notably worse for women, and has been identified as an international concern. Key contributors to burnout within radiation oncology include inadequate clinical and administrative support, imbalanced personal and professional lives including time with family and for self-care, decreased job satisfaction secondary to increased electronic medical record and decreased patient time, unsupportive organizational culture, lack of transparency from leadership and inclusion in administrative decisions, emotionally intensive patient interactions, challenges within the radiation oncology workforce, financial security related to productivity-based compensation and increasing medical training-related debt, limited education on wellness, and fear of seeking mental health services due to stigma and potential negative impacts on the trajectory of one's career. Limited data exist to quantify the impacts of these factors on the overall levels of burnout within radiation oncology specifically, and additional efforts are needed to understand and address root causes of burnout within the field. Strategies should focus on improving the systems in which physicians work and providing the necessary skills and resources to thrive in high-stress, high-stakes work environments.

Hospital-based proton therapy implementation during the COVID pandemic: early clinical and research experience in a European academic institution.

INTRODUCTION: A rapid deploy of unexpected early impact of the COVID pandemic in Spain was described in 2020. Oncology practice was revised to facilitate decision-making regarding multimodal therapy for prevalent cancer types amenable to multidisciplinary treatment in which the radiotherapy component searched more efficient options in the setting of the COVID-19 pandemic, minimizing the risks to patients whilst aiming to guarantee cancer outcomes. METHODS: A novel Proton Beam Therapy (PBT), Unit activity was analyzed in the period of March 2020 to March 2021. Institutional urgent, strict and mandatory clinical care standards for early diagnosis and treatment of COVID-19 infection were stablished in the hospital following national health-authorities' recommendations. The temporary trends of patients care and research projects proposals were registered. RESULTS: 3 out of 14 members of the professional staff involved in the PBR intra-hospital process had a positive test for COVID infection. Also, 4 out of 100 patients had positive tests before initiating PBT, and 7 out of 100 developed positive tests along the weekly mandatory special checkup performed during PBT to all patients. An update of clinical performance at the PBT Unit at CUN Madrid in the initial 500 patients treated with PBT in the period from March 2020 to November 2022 registers a distribution of 131 (26%) pediatric patients, 63 (12%) head and neck cancer and central nervous system neoplasms and 123 (24%) re-irradiation indications. In November 2022, the activity reached a plateau in terms of patients under treatment and the impact of COVID pandemic became sporadic and controlled by minor medical actions. At present, the clinical data are consistent with an academic practice prospectively (NCT05151952). Research projects and scientific production was adapted to the pandemic evolution and its influence upon professional time availability. Seven research projects based in public funding were activated in this period and preliminary data on molecular imaging guided proton therapy in brain tumors and post-irradiation patterns of blood biomarkers are reported. CONCLUSIONS: Hospital-based PBT in European academic institutions was impacted by COVID-19 pandemic, although clinical and research activities were developed and sustained. In the post-pandemic era, the benefits of online learning will shape the future of proton therapy education.

EVALUATION OF THE EFFECT OF THE COVID-19 PANDEMIC ON THE TREATMENT OF RADIATION ONCOLOGY PATIENTS

Background: Patients undergoing cancer treatment and people with a history of cancer constitute a high-risk patient group in the COVID-19 pandemic. In this study, we aimed to evaluate the life effect of the COVID-19 pandemic on the treatment processes of cancer patients receiving radiotherapy at our hospital's Radiation Oncology Clinic. Methods: Sociodemographic data, COVID-19 pandemic awareness, vaccination and disease transmission of the Radiation Oncology Clinic's patients were administered with a written questionnaire that includes the effects of the pandemic on the treatment between 1st and 30th June of 2021. Results: 7 (13.2%) of the patients had COVID-19 infection during the treatment processes, the in-home index was 4 (57%) due to contact with the case (p<0.001). 4 of the patients (7.5%) stated that they had experienced disruptions in their treatment processes caused by the health institution and 4 of the patients (7.5%) stated that they had experienced disruptions in their treatment processes caused by personal anxiety and anxiety during the pandemic process. 8 patients (15%) stated that they had concerns that they would receive incomplete treatment due to the pandemic process, while one patient (1.9%) stated that they had received psychological support and psychiatric medication due to this anxiety and fear. 9 patients (17%) stated that the covid-19 pandemic had a negative effect on oncological disease treatment processes. Conclusion: It is important that the treatment and follow-up of cancer patients, who are a at-risk group for COVID-19 infection, should continue without interruption, accompanied by up-to-date national and international guidelines.

COVID-19 testing trends: pre-radiation and throughout cancer care

Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.

Implementation and Assessment of an Informal Virtual Elective for Medical Student Radiation Oncology Exploration During the COVID19 Pandemic: a Brief Report.

Subspecialty exposure during medical school can be limited. Moreover, the COVID19 pandemic prevented most onsite elective medical student (MS) rotations during 2020. Therefore, we sought to create and assess the efficacy of an informal virtual elective (IVE) for MSs to explore radiation oncology (RO) at our institution. We created IVE activities including invitations to resident didactics, a faculty lecture series, and interactive virtual events with residents and faculty. MSs were offered RO resident and faculty mentors and the opportunity to deliver a lecture. Pre- and post-IVE evaluation surveys were sent to 27 4th year MSs. Surveys utilized importance ordering (1=most important; reported as median (interquartile range), free response, and Likert-type questions (5 = extremely, 1=not at all). Our IVE, held from July to October 2020, had a median of 11 students (range 7-18) attend each activity. Pre- and post-IVE surveys were completed by 22/27 (81%) and 20/27 (74%) MSs, respectively. In pre-IVE, MSs reported participating in the IVE for faculty/resident interaction (1.5 [1, 2]), networking (3 [2, 3]), and learning (4 [3-5]). In post-IVE, MSs reported benefit from faculty mentors (5 [4, 5]), delivering a presentation (5 [3-5]), and faculty lectures (4.5 [4, 5]). In post-IVE, MSs preferred a full onsite away elective (16, 80%) over an official virtual elective (1, 5%) or IVE (3, 15%). Overall, MSs reported that the IVE provided an adequate introduction to RO at our institution (4 [4, 5]). Alternative virtual elective experiences allow MSs to informally evaluate medical subspecialties and could be offered even if formal elective opportunities are available.

Quality of teaching radiation oncology in times of COVID-19 - an analysis of challenges and opportunities

Background: The COVID-pandemic has challenged medical education on multiple levels. Radiation Oncology (RO) is a pivotal clinical discipline for the understanding of modern oncology concepts [1]. The following analysis aims at providing an overview of students' evaluation of RO teaching in the pre- and pandemic situation. Method(s): RO curriculum at our faculty is organized longitudinally spanning all clinical semesters which are analyzed here. Students' evaluation is mandatory and done on a 101-item Likert scale (0-100;with 0 being the best grade). Starting from summer semester 2020 onward, lectures were digitalized and digital implementation was rated on a 11-item Likert scale (-5-+5;with -5 being the best grade). Evaluation results and participant numbers between winter semester 2018/2019 and summer semester 2021 were assessed, the first three semesters being classified as "pre-pandemic" and the later three as "pandemic". Result(s): Lectures were rated with a median 18.5-21.5 for the 2nd-6th clinical semester. Comparison between pre-pandemic and pandemic semesters revealed a deterioration of 1-3 points. Median participants numbers were 63.5-89 with an increase of 12-20 in the pandemic semesters except for the 6th clinical semester. The percentage of students attending 75 % of RO lectures in one semester increased considerably (median: 41.4 % vs. 75.3 %). Digital implementation was rated with a median score of -2 to 0. Discussion(s): Differences between pre-pandemic and pandemic evaluations are consistent but small and are unlikely a sign of students' discontent. Digital formats could augment the numbers of participants as well as the percentage of presence. Digital implementation was evaluated to be average to good. Conclusion(s): Digital transfer of RO is feasible and good evaluation results are maintained. Additional concepts with a web-based learning platform and videocasts are currently being developed.

The Effect of COVID-19 on Radiation Oncology Practice in Turkiye

OBJECTIVE COVID-19 (Coronavirus Disease-19) was the name given to a novel pneumonia outbreak that occurred in Wuhan (Hubei province, China) in December 2019. For patients undergoing or scheduled for radiation therapy, radiation oncology (RO) departments were required to adjust their management protocols to maintain their ability to provide optimal care. The present survey study assesses the change in the daily practices of Turkish radiation oncologists. METHODS An online questionnaire was developed in Google Forms and sent out to oncologists registered with the Turkish society for RO. A total of 98 radiation oncologists completed the online questionnaire after three reminders were sent to the recipients over the course of 1 week. RESULTS After the pandemic has started, 65% of radiation oncologists moved their wards and outpatient clinics to different hospital units, resulting in an approximate 70% decline in the delivery of patient services in RO. Since the beginning of the pandemic in Turkiye, 52% of radiation oncologists have not been assigned to services related to COVID-19. Around half of the radiation oncologists surveyed stated that they were shunned by the society due to fear of transmitting the COVID-19 infection. CONCLUSION Further studies are needed to steer the creation of new regulations related to radiation oncologists, to be applied in the event of such emergencies as the COVID-19 pandemic. Copyright © 2022, Turkish Society for Radiation Oncology.