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Purpose or Objective: The COVID-19 pandemic has required rapid and repetitive adjustment of radiotherapy practice, hospital and department organization and hygienic measures. This has been in parallel with significant changes in everyone’s private life. In the Department of Radiation Oncology, University Zurich, all employees were invited to participate in weekly assessments of their stress levels, aiming to rapidly and precisely implement anti-stress measures. Materials and Methods: Starting from March 31st 2020, weekly anonymized surveys were distributed to all employees (n=134) of the Department of Radiation Oncology, University of Zurich. Survey Monkey was used, and distribution was performed via email. The survey asked about the profession (clinician, medical physics and dosimetry, RTT, nurse, administration and research) and whether work in the last week was performed in hospital with or without patient contact or in home office. Global stress level during the last week was assessed on a 10-point scale. Additionally, stress was assessed in the sub-categories: concerns about own health;concerns about health of family & friends;concerns about patients` health. Results: Between March 31st 2020 and February 17th 2021, a total of 47 surveys resulted in 1733 responses, 37 responses on average (range 26 and 54). Response rate was 28% on average and did not change over time, overall and in each profession. Averaged over all responses, the global stress level varied substantially between professions, ranging between 2.8 for administration and 6.8 for RTTs. The global stress level was highest for in-hospital work with patient contact with an average of 4.7, whereas stress was similar for in-hospital work without patient contact and home-office with 3.5 and 3.8, respectively. Concerns about health were highest about family & friends with 4.0 on average compared to concerns about the own health and of the patients with average values of 3.1 and 3.5, respectively. Changes of global stress level over the 47 weeks were strongly associated with development of the pandemic (figure). Averaged over all employees, the global stress level stated with 4.8 on average in March 2020 and dropped continuously in the spring and summer months until the second COVID-19 wave started in September 2020 with two peaks in November and December with 5.5 and 5.7 on average, respectively. Interventions against high stress levels were performed for all professions and especially the RTT subgroup with highest stress levels (workshops;meditation room;detailed information about hospital-specific infection rates;information about hospital wide possibilities for coping mechanisms, effectiveness of PPE;team meetings).

Purpose or Objective: On 30 January 2020,WHO declared the outbreak of coronavirus disease 2019(COVID19).As cancer patients are already considered at increased risk of persistent depressive and anxiety disorders, the aim of this study was to evaluate psycological impact of the COVID19 pandemic in these patients.Psychological counseling services were offered to patients who showed anxiety and stress above selected cut off levels. Materials and Methods: All consecutive adult cancer outpatients between April and May 2020 were prospectively enrolled in this study and therefore received structured and validated ad-hoc questionnaires.Emotional distress was measured by means of visual scale.The structured questionnaire consisted of questions covering several areas such as knowledge and concerns about COVID19,the psychological impact of the COVID19 outbreak and mental health.Validated self-assessment questionnaires for the evaluation of psychological functioning and resilience skills were:1)Connor-Davidson Resilience Scale(CD-RISC-25) investigating five factors of resilience;2)Beck Depression Inventory-II(BDI-II)consisting of 21 items evaluating the severity of depression;3)State and Trait Anxiety Inventory(STAI-¬TRAIT-Y) investigating the anxiety-trait and anxiety-state. Results: A total of 208 patients completed the survey with a participation rate of 99%. Most of patients(79.3%) were in treatment and 20.7% in follow up.70 patients(42.7%) received palliation treatment and 94(57.3%) curative treatment. Patients who cohabited with others declared themselves to be more resilient;the COVID related physical concern is worse in those with lung cancer than in other cancers and in those on active treatment compared to follow up. COVID-related physical concern correlates significantly with depression, distress, and state and trait anxiety. (Figure Presented) Conclusion: During COVID19,depression and emotionality were limited in our patients.Physical concern,as expected due to the cancer diagnosis,was present in this cohort of patients and was higher in treatment compared with follow up patients.COVID19 worsens Trait-Anxiety in all patients.

Purpose or Objective: the impact of COVID-19 has been overwhelming on cancer patients, who may be at higher risk of developing severe disease. Outstandingly, the aftermath on neoplastic patients is still largely unknown, remarkably regarding SARS-Cov-2 infection during radiotherapy. In this paper we report the experience of our Department, set in Lombardy, one of the regions most affected by the pandemic worldwide. Materials and Methods: data of cancer patients with ongoing on planned active treatment during the first and second “wave” of the pandemics were retrospectively analyzed. We compared a cohort of 402 cancer patients undergoing active treatment from February 24 to April 24, 2020 (when RT-PCR for SARS-Cov-2 on naso-pharyngeal swabs - NPS - were performed only in case of suggestive symptoms and/or contacts at risk) and a cohort represented by all the 636 patients with planned active treatment at Brescia University Radiation Oncology Department from October 31,2020 to February 06, 20121. In the latter group, all the subjects were screened for SARS-Cov-2 RNA with NPS before treatment start and every 10 days during treatment, as for institutional policy. Results: during the first “wave”, dedicated measures allowed an overall limited infection rate of 3.23% (13/402) and mortality of 1.24% (5/402);remarkably, 92.3% of the cases were detected before March 24. Nevertheless, mortality among COVID-19 patients was high (38.5%) and all the patients were symptomatic, with 46.5% presenting with severe disease. Globally, only 2.5% of ongoing treatments were suspended due to suspect or confirmed COVID-19 and 46.2% of positive patients carried on radiotherapy without interruption. During the second “wave”, a universal screening was implemented for all the patients with planned active treatment. A total of 1243 NPS was performed on 636 patients. The infection rate was 2.52% and 81.3% of the patients with a positive NPS was asymptomatic, two had mild disease and one severe disease that lead to death. All the patients already on treatment with mild or asymptomatic COVID-19 carried on the therapy with no or minimal delay. Median delay for patients with infection detected before treatment start was 16.5 days. Conclusion: detected incidence of COVID-19 was lower during the second outbreak in our patients (2.52% vs 3.23%), despite the extensive testing schedule that also substantiates the high rate of asymptomatic infections and the low mortality among COVID-19 patients (6.3% vs 38.5% during the first outbreak). A universal SARS-Cov-2 screening for all the patients with planned treatment might allow an early identification of COVID-19 patients, resulting in a timely management that could improve clinical outcomes and prevent the spread of the infection.