How to reorganize the access of children in a radiotherapy department in the era of COVID19, in order to protect themselves and elderly patients According to Liang 1 , as of Jan 31, 2020, based on a cohort of patients in China, 1% of coronavirus disease (COVID-19) cases had a history of cancer. Although direct evidence is lacking to support changing or withholding anticancer therapy in cancer patients 2,3 , the report showed that they had poorer outcomes from COVID-19, especially older patients 1 Our Cancer Institute, located in North-Eastern Italy, treats 120 outpatients daily with radiotherapy, coming from different Italian regions: 52% are over 65 years of age (several with co-morbidities) and 7% are younger than 10 years. Most children are enrolled in clinical trials and treated daily with high conformal techniques and conventional fractionation.
Starting mid-February 2020, we applied these rules for outpatients undergoing radiotherapy: 1) telephonic triage the day before the first admission, and specific clinical triage the day of admission in a dedicated area; 2) daily detailed medical history to detect the possibility of COVID-19 contagion; 3) postponement of non-essential check-ups; 4) medical evaluation or nasopharyngeal swab for patients with rhinitis, conjunctivitis, cough or fever in order to access the hospital; 5) education on hand-washing, no touching mouth, nose, and eyes; 6) couch and mask disinfection after every radiotherapy fraction; 7) compulsory surgical masks for patients, parents and healthcare workers; 8) no volunteers allowed; 9) nasopharyngeal swabs only for people with symptoms or family risk conditions. Specific rules for children: 1) different waiting rooms for adults and children; 2) only one parent allowed; 3) no patient overlapping; 4) only one patient in need of sedation per recovery room; 5) individual toys for each child to be later disinfected; 6) suspension of hospital school and limitation of psychological support.
In most hospitals worldwide, the radiotherapy department is shared by pediatric, adult and elderly patients. Therefore, although we are along a learning curve which is still ongoing 11 , we have applied these measures to avoid the transmission of COVID-19 from asymptomatic or mild-symptomatic patients, i.e. pediatric patients, to ones with an increased death risk, i.e. the elderly. As of today, none of the patients in treatment at our Department have developed signs or symptoms of COVID-19 infection.