How is your life during the last year (pandemic year 2020-2021)?

[Radonc90]

It is now a year into the pandemic. How are you guys/girls doing?

For me...

PROFESSIONAL STUFF:

- Re Covid, early in the pandemic (Feb. 2020), I told all my staff to wear mask bc this is respiratory
virus, and after I read early studies published in Pre-Print websites...
- There was some initial hesitancy to wear masks by the staff bc the hospital at that time did not
require masks (yet). Later, the staff thanked me for that!

- Re Covid surface contamination study published in NEJM, I never thought this
is a primary mode of spread. So we cleaned the Linac table as usual (SOP), no extra step.
Of course we washed our hands and the Linac tables after each pt, but never
resorted to treating "Covid pts at the end of the day and do deep cleaning" thingy.

- I never thought pts coming to our clinic is riskier than going to grocery store and
for now I avoid "extreme" hypofx. Just go with current level of data and I do not
let the "fear of getting Covid when visiting radonc clinic" bother me.

- Breast: is 16 fx + 5 fx boost. I am not doing 5 fx (yet).

- Prostate: 43 fx down to 22-24 fx etc.

- Head-Neck: still 60Gy-70Gy (depending on HPV P16 status).

- Lung still 60Gy for IIIA, IIIB, concurrent chemo. Durva later.

- Lung SBRT: no change, still 5 fx.

- GBM: short-course.

- Rectum: TNT approach when appropriate, for RT it is a mix of
50.40 Gy (concurrent chemo) or the Swedish thingy 5 Gy x 5.


BUSINESS SIDE:

- Pt volume drops from 100% (pre-pandemic) to about 60% during the last year. It is what it is.
My theory is pts are afraid to come in for screening etc., so there may or may not be
a tsunami of advanced cancer cases in the near future. If there is a tsunami of advanced
cases, it is mostly for medonc or palliative care, we (and the surgeons) lose the early curative cases.
Or maybe pts take a fatalistic approach to cancer care (dying at home), I don't know.


COMMUNITY-HUMANITY SIDE:

- I volunteer to homeless clinic run by med school to help out the med students.
It gives me a sense of "worthiness" and although I am not depressed, but seeing
the damage done to the institution by DJT during the last year (glad #45 is gone)
is depressing.
But volunteering helps bc it brings back the humanity thing.

- If local people ever need me to inject the vaccines, I will volunteer to help with the vaccination process.


FAMILY-SOCIAL LIFE:

- On the weekend, I have a bit more time, so I call my bros/sis who live far away,
it is amazing we had lived such busy life, we rarely called each other, even on the weekend!
Now we connect more. Maybe landline phone or Zoom. It is much better now.

- Local Food Pantry: I donate money to charity and buy dry food on sales at grocery stores
(such as dry pasta etc.) and donate them. There are a lot of hungry people out there!

- Winter clothes from my kids: I donate them to local charity.

- I support local business, I avoid chain business. So for morning cappuccino I go to local coffee shop.
Restaurant: I support local restaurants.
I avoid dine-in, but order to-go Pizza, Greek food, Pasta, or Biryani.
Sometimes the food is only $15-$20, but I give the waiter/waitress some $20 tip.
Very often, they are surprised at the amount of tip I give them.
A lot of these people are struggling. I am not rich, I have kids in college to feed, but what the hell,
these resto workers are human beings too, they suffer a lot financially...

- I play more music now, it is different when you play music vs listening to it.
It is much more gratifying to play music...

- I avoid TV (maybe 5 min at night to catch up with news), limit Twitter to 5-10 min/day.

- I also exercise more (not in the gym but at home), and I now feel much better.
Get a 10-lb or 15-lb weight ($15 at Target, Walmart etc.) and do arm-leg exercise. Then sit-up push-up etc.
Usually I do this while watching TV. About 15-30 min of exercise/day...

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[radonc17]

It is now a year into the pandemic. How are you guys/girls doing?

For me...

PROFESSIONAL STUFF:

- Re Covid, early in the pandemic (Feb. 2020), I told all my staff to wear mask bc this is respiratory
virus, and after I read early studies published in Pre-Print websites...
- There was some initial hesitancy to wear masks by the staff bc the hospital at that time did not
require masks (yet). Later, the staff thanked me for that!

- Re Covid surface contamination study published in NEJM, I never thought this
is a primary mode of spread. So we cleaned the Linac table as usual (SOP), no extra step.
Of course we washed our hands and the Linac tables after each pt, but never
resorted to treating "Covid pts at the end of the day and do deep cleaning" thingy.

- I never thought pts coming to our clinic is riskier than going to grocery store and
for now I avoid "extreme" hypofx. Just go with current level of data and I do not
let the "fear of getting Covid when visiting radonc clinic" bother me.

- Breast: is 16 fx + 5 fx boost. I am not doing 5 fx (yet).

- Prostate: 43 fx down to 22-24 fx etc.

- Head-Neck: still 60Gy-70Gy (depending on HPV P16 status).

- Lung still 60Gy for IIIA, IIIB, concurrent chemo. Durva later.

- Lung SBRT: no change, still 5 fx.

- GBM: short-course.

- Rectum: TNT approach when appropriate, for RT it is a mix of
50.40 Gy (concurrent chemo) or the Swedish thingy 5 Gy x 5.


BUSINESS SIDE:

- Pt volume drops from 100% (pre-pandemic) to about 60% during the last year. It is what it is.
My theory is pts are afraid to come in for screening etc., so there may or may not be
a tsunami of advanced cancer cases in the near future. If there is a tsunami of advanced
cases, it is mostly for medonc or palliative care, we (and the surgeons) lose the early curative cases.
Or maybe pts take a fatalistic approach to cancer care (dying at home), I don't know.


COMMUNITY-HUMANITY SIDE:

- I volunteer to homeless clinic run by med school to help out the med students.
It gives me a sense of "worthiness" and although I am not depressed, but seeing
the damage done to the institution by DJT during the last year (glad #45 is gone)
is depressing.
But volunteering helps bc it brings back the humanity thing.

- If local people ever need me to inject the vaccines, I will volunteer to help with the vaccination process.


FAMILY-SOCIAL LIFE:

- On the weekend, I have a bit more time, so I call my bros/sis who live far away,
it is amazing we had lived such busy life, we rarely called each other, even on the weekend!
Now we connect more. Maybe landline phone or Zoom. It is much better now.

- Local Food Pantry: I donate money to charity and buy dry food on sales at grocery stores
(such as dry pasta etc.) and donate them. There are a lot of hungry people out there!

- Winter clothes from my kids: I donate them to local charity.

- I support local business, I avoid chain business. So for morning cappuccino I go to local coffee shop.
Restaurant: I support local restaurants.
I avoid dine-in, but order to-go Pizza, Greek food, Pasta, or Biryani.
Sometimes the food is only $15-$20, but I give the waiter/waitress some $20 tip.
Very often, they are surprised at the amount of tip I give them.
A lot of these people are struggling. I am not rich, I have kids in college to feed, but what the hell,
these resto workers are human beings too, they suffer a lot financially...

- I play more music now, it is different when you play music vs listening to it.
It is much more gratifying to play music...

- I avoid TV (maybe 5 min at night to catch up with news), limit Twitter to 5-10 min/day.

- I also exercise more (not in the gym but at home), and I now feel much better.
Get a 10-lb or 15-lb weight ($15 at Target, Walmart etc.) and do arm-leg exercise. Then sit-up push-up etc.
Usually I do this while watching TV. About 15-30 min of exercise/day...

Impressive!

 

[Palex80]

- Re Covid surface contamination study published in NEJM, I never thought this
is a primary mode of spread. So we cleaned the Linac table as usual (SOP), no extra step.
Of course we washed our hands and the Linac tables after each pt, but never
resorted to treating "Covid pts at the end of the day and do deep cleaning" thingy.

I understand what you are saying, but I would still treat confirmed cases at the end of the day. Reasons:
Surfaces are perhaps a minor issue, but these patients can still produce aerosols and if they do not correctly carry PPE, they can still spread the virus around. Furthermore, treating them at the end of the day (or at less busy hours), means that these contagious patients will have less contact with other people simply because at the end of the day there are less people around. And this does not mean only at your department but everywhere on their way to treatment and back home.

- I never thought pts coming to our clinic is riskier than going to grocery store and
for now I avoid "extreme" hypofx. Just go with current level of data and I do not
let the "fear of getting Covid when visiting radonc clinic" bother me.

This is true. On the other hand most of us have a grocery store around the corner, only a few patients have a radiation oncology department around the corner. Having to commute for treatment, if this involves taking the bus, uber or have a friend drive you to treatment means a higher risk of getting infected or spreading the virus. Minimizing "contacts" between people is essential. I would not resort to ultra-hypofractionation and you already list very good fractionation schedules, well done!

Pt volume drops from 100% (pre-pandemic) to about 60% during the last year. It is what it is.
My theory is pts are afraid to come in for screening etc., so there may or may not be
a tsunami of advanced cancer cases in the near future. If there is a tsunami of advanced
cases, it is mostly for medonc or palliative care, we (and the surgeons) lose the early curative cases.
Or maybe pts take a fatalistic approach to cancer care (dying at home), I don't know.

I have the impression we are seeing some advanced cases that may have been picked earlier on. It may be congitive bias though. We are thinking of looking into that next year: compare stage of breast cancer diagnosed in 2018&2019 compared to 2020&2021 and see if there's a pattern. Breast cancer screening was paused for >6 months last year. That would be a great project with SEER-data by the way...

 

[ramsesthenice]

I understand what you are saying, but I would still treat confirmed cases at the end of the day. Reasons:
Surfaces are perhaps a minor issue, but these patients can still produce aerosols and if they do not correctly carry PPE, they can still spread the virus around. Furthermore, treating them at the end of the day (or at less busy hours), means that these contagious patients will have less contact with other people simply because at the end of the day there are less people around. And this does not mean only at your department but everywhere on their way to treatment and back home.


This is true. On the other hand most of us have a grocery store around the corner, only a few patients have a radiation oncology department around the corner. Having to commute for treatment, if this involves taking the bus, uber or have a friend drive you to treatment means a higher risk of getting infected or spreading the virus. Minimizing "contacts" between people is essential. I would not resort to ultra-hypofractionation and you already list very good fractionation schedules, well done!


I have the impression we are seeing some advanced cases that may have been picked earlier on. It may be congitive bias though. We are thinking of looking into that next year: compare stage of breast cancer diagnosed in 2018&2019 compared to 2020&2021 and see if there's a pattern. Breast cancer screening was paused for >6 months last year. That would be a great project with SEER-data by the way...

Colorectal and esophageal cancers are coming in more advanced in our region but they more or less quit scoping for a few months and then had a slow ramp up. I’m getting tired of writing HPIs that start with BRBPR in March and then have biopsy confirmation in October ☹️

the bigger question is did it compromise outcomes or survival? My guess is not as much as one might expect at first blush. But in a couple years I’m sure there will be a lot of papers looking into it.

 

[evilbooyaa]

Great to see, OP, that you're maintaining physical and mental health throughout this.

The only thing I would comment on your post, is that I would recommend you treat patients that have been confirmed positive for COVID at the end of the day and do a terminal clean after the final patient. While YOU may not feel that surface contamination is significant, IMO you are not going with the 'SOC' and open yourself up to liability if a second patient develops COVID while under beam, and it's discovered that you 1) knew you were treating a COVID+ patient, and 2) that patient was treated prior to the second patient.

If you wanted to omit the 'deep clean' (I don't really know what this means), I could rationalize that.

 

[wandering star]

I also exercise more (not in the gym but at home), and I now feel much better.

Hey OP, lovely thread and idea. Thank you for sharing.

I stopped going to the gym (closed) and started eating cookies and pastries. Last week I stepped on a scale for the first time in a long time and found that I gained 15 pounds last year! (I am still at the edge of "normal" as per BMI but have stopped buying cookies. I still have a backlog though in my pantry, we'll see if my determination holds out after I run out)

The clinic here is actually up in volume, maybe 25% or so, and folks are busier than ever. No idea why. It's a more rural area with no obvious competition in a 30 minute drive. I also would have expected less volume from less screening but it turns out not to be the case.

 

[seper]

For me, past year was constant worry about my own personal safety. Multiple pts got symptomatic Covid under the beam. One man with rectal Ca died midway from Covid with resp. failure. A GI nurse in the same hospital wing died of Covid. Had a nice vigil for her. At one point, hospital had almost 200 pCR+ pts and built a tent addition.
Enjoying a little respite now after finally getting Moderna shot.

 

[ramsesthenice]

For me, past year was constant worry about my own personal safety. Multiple pts got symptomatic Covid under the beam. One man with rectal Ca died midway from Covid with resp. failure. A GI nurse in the same hospital wing died of Covid. Had a nice vigil for her. At one point, hospital had almost 200 pCR+ pts and built a tent addition.
Enjoying a little respite now after finally getting Moderna shot.

Oh my god. That is horrible. Our state numbers look horrible but most of the burden was taken on by the community hospitals in our vast Trump country. I don't personally know any heal care workers who died of COVID (although there is 1 not doing great now). I had one patient die about a month after finishing radiation but we really didn't have many patients we were aware of who even had it while on beam despite averaging around 100 per day during the COVID pandemic.

Hey OP, lovely thread and idea. Thank you for sharing.

I stopped going to the gym (closed) and started eating cookies and pastries. Last week I stepped on a scale for the first time in a long time and found that I gained 15 pounds last year! (I am still at the edge of "normal" as per BMI but have stopped buying cookies. I still have a backlog though in my pantry, we'll see if my determination holds out after I run out)

The clinic here is actually up in volume, maybe 25% or so, and folks are busier than ever. No idea why. It's a more rural area with no obvious competition in a 30 minute drive. I also would have expected less volume from less screening but it turns out not to be the case.

That would have been me if my wife hadn't convinced me to buy her a treadmill (pre-covid) which I knew she would never use. I started using it mainly because I was getting pissed just seeing it sit there but eventually got to a point I am lifting or running at home most days. Im probably in the best shape of my adult life. Not gonna lie. Our wine consumption has skyrocketed and she bakes when she is stressed. I could VERY easily be up 15-20 pounds if not for the running.

 

[Radonc90]

- I diagnosed a few pts with asymptomatic Covid just by looking at CT sim done for something else (breast ca etc.).
These pts' Covid resolved on their own.

- I lost a few pts to Covid (stage IV lung ca, stage IV breast ca) simply bc they were immuno-compromised. This happened roughly 1 month post palliative RT. Felt bad for them bc if they are still alive, they should be the first to get the vaccines.

- My internists friends advise their pts to eat Mediterranean diet. I tell my pts the same.
I also like Mediterranean diet...

I am glad there is this community where we can support each other, not just radonc's topics but also "pandemic life" topics...Thank you all for sharing your stories, this is uplifting!

PS: Mayo clinic has a nice article on Mediterranean diet:

Mediterranean diet for heart health

This heart-healthy eating plan emphasizes healthy fats, whole grains, fruits, vegetables, beans, nuts and seeds.

www.mayoclinic.org

 

[Radonc90]

So, this is weekly check on patients (OTV On-Tx Visit)...

- Pt #1: 85 yo black man with prostate cancer (Gleason 8): "doc, can I get Johnson Johnson vaccine bc it is one shot?"
Me: "You should get whatever available bc at your age, Covid is no joke".
Pt: "OK, doc, I trust you" (So goooood to hear this!)
Me: "We only have Pfizer at our hosp but 2 shots".
Pt: "I don't have a computer and don't know how to set up an appointment".
Me: "No problem, we will get someone to escort you to the vaccine clinic"....
One hour later, the pt had his first vaccine dose!

- Pt #2: 90 yo black man with lung cancer (SBRT pt). Me: "Have you had the vaccine yet?"
Pt: "No, we don't go out, just 2 of us at home, we don't even allow kids, grandkids to come over our house".
Me: "You should get the vaccine anyway".
Pt: "We don't trust the government with confusing messages about Pfizer, Moderna, Johnson & Johnson etc."
Me: "We will talk again" (Hey, I am not a quitter, I am very very persistent...)
Pt: "doc, I am 90 yo, I have lived my life...", then he laughed. I laughed too...
Me: "I hate to cure you with SBRT, then you die from Covid".
Pt: "OK, we trust you, but we need to think about it..."

So there you go, once you enter the pt's world, it is fascinating that some patients have so much distrust for the government. Also the misinformation from the Trump regime did not help.

So, guys/girls, don't forget to discuss Covid vaccine with your pts during weekly check, they (cancer patients, even younger patients) are HIGH RISK if they get the virus!!! If your hospital has vaccine clinic, negotiate and push hard (especially those younger pts who don't fit in the age bracket) to get your pts vaccinated...

 

[RadOncDoc21]

Remember back in the day when you had to rank every program and just hoped to match? Do you know how much PD a$$ I had to kiss?

Edit: My bad, this was in response to the ranking Baylor thread but I still think it fits here!

 

[medgator]

Remember back in the day when you had to rank every program and just hoped to match? Do you know how much PD a$$ I had to kiss?

The ass kissing has now gone in reverse i bet if you're an AMG with a clean background check.

Pucker up, PDs!

 

[ramsesthenice]

The ass kissing has now gone in reverse i bet if you're an AMG with a clean background check.

Pucker up, PDs!

We are way past kissing. Two words buddy: Tossed Salad. So glad I’m not a PD 🙂

 

[medgator]

We are way past kissing. Two words buddy: Tossed Salad. So glad I’m not a PD 🙂

Obligatory Chris rock primer... NSFW

 

[metallica81788]

So, this is weekly check on patients (OTV On-Tx Visit)...

- Pt #1: 85 yo black man with prostate cancer (Gleason 8): "doc, can I get Johnson Johnson vaccine bc it is one shot?"
Me: "You should get whatever available bc at your age, Covid is no joke".
Pt: "OK, doc, I trust you" (So goooood to hear this!)
Me: "We only have Pfizer at our hosp but 2 shots".
Pt: "I don't have a computer and don't know how to set up an appointment".
Me: "No problem, we will get someone to escort you to the vaccine clinic"....
One hour later, the pt had his first vaccine dose!

- Pt #2: 90 yo black man with lung cancer (SBRT pt). Me: "Have you had the vaccine yet?"
Pt: "No, we don't go out, just 2 of us at home, we don't even allow kids, grandkids to come over our house".
Me: "You should get the vaccine anyway".
Pt: "We don't trust the government with confusing messages about Pfizer, Moderna, Johnson & Johnson etc."
Me: "We will talk again" (Hey, I am not a quitter, I am very very persistent...)
Pt: "doc, I am 90 yo, I have lived my life...", then he laughed. I laughed too...
Me: "I hate to cure you with SBRT, then you die from Covid".
Pt: "OK, we trust you, but we need to think about it..."

So there you go, once you enter the pt's world, it is fascinating that some patients have so much distrust for the government. Also the misinformation from the Trump regime did not help.

So, guys/girls, don't forget to discuss Covid vaccine with your pts during weekly check, they (cancer patients, even younger patients) are HIGH RISK if they get the virus!!! If your hospital has vaccine clinic, negotiate and push hard (especially those younger pts who don't fit in the age bracket) to get your pts vaccinated...

You have to bring up the vaccine yourself at OTVs?

I get on-treat patients, new consults, follow-ups, everybody asking me things about the vaccine (logistics mostly) nearly every day. It's annoying so I just tell them all to get it without elaborating much.