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Purpose Mitigation strategies to balance the risk of coronavirus disease 2019 (COVID-19) infection against oncologic risk in patients with breast cancer undergoing radiation therapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiation therapy by oncologic risk and omission or deferral of radiation therapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers and preserves resources. Herein, we present our early response and adaptation of breast radiation therapy utilization during the COVID-19 pandemic at a large academic cancer center in Canada. Methods and Materials A state of emergency was announced in Ontario on March 17, 2020, owing to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast radiation therapy starts, type of breast radiation therapy, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019. Results After the declaration of emergency in Ontario, there was a decrease of 39% in radiation therapy starts in 2020 compared with 2019 (79 vs 129, P < .001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared with 2019 (46% vs 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiation therapy were aged >50 years in 2020, 66% (78 of 118) versus 83% (132 of 160) in 2019, P = .0027. Conclusions A significant reduction in breast radiation therapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiation therapy to patients associated with higher oncologic risk requiring RNI. A quick response to a health care crisis is critical and is of particular importance for higher volume cancer sites where the potential effect on resources is greater.

Purpose The COVID-19 pandemic has propelled health care workers (HCW) to the frontlines against the pandemic. In addition to the anxiety related to infection risks, trainees have the additional burden of learning and career planning while providing care in an uncertain and rapidly changing environment. We conducted a survey to evaluate the practical and psychosocial impact on radiation oncology fellows during the first month of the pandemic. Methods and Materials A 4-part survey was designed and distributed to the fellows in our program. The survey was designed to evaluate the impact of the pandemic on “Scope of activity”, “Well being (Impact on you)”, to identify “Key lessons learned” and “Social factors (About you)” using Likert scales, and open-ended response options. The survey included items from the Oldenburg Burnout questionnaire. Results A total of 17 (71%) participants responded to the survey. While there was a significant reduction in the mean time spent on in-person clinics [13.5 hours/week (pre-COVID) vs 9.3 hours/week (week 3-COVID); p = 0.002]. This was replaced by virtual consults and other COVID related activities. The proportion of respondents demonstrating features of burnout in the domains of “disengagement” and “exhaustion” was 71% and 64% respectively. However, there was also evidence of resilience with 47% respondents “feeling energized”. Top ‘’concerns’’ and ‘’negative changes’’ identified related to learning, infection risk, and safety, patient care, coping, and concerns about their home country. Top ‘’positive changes’’ highlighted include work culture, appreciation for leadership caring for the team, the insistence on evidence to guide change, and the implementation of virtual health care. Conclusions Negative impact needs to be anticipated, acknowledged, and managed. We anticipate understanding the positives that have emerged under these extraordinary circumstances is the “silver-lining’’ of the pandemic, giving us tools and the best leverage to plan for the future., The COVID-19 pandemic has propelled health care workers to the frontlines and increased the risk of anxiety and burnout amongst our trainees. We conducted a survey to evaluate the practical and psychosocial impact of the pandemic on the fellows in our program. Understanding the positives that have emerged under these extraordinary circumstances is the “silver-lining’’ of the pandemic, giving us the best leverage to plan the future. Negative impact must be anticipated, acknowledged, and managed appropriately.