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Table 1 Strategies to reduce risk of COVID-19 transmission at Guy’s Cancer Centre

From: Safe provision of systemic anti-cancer treatment for urological cancer patients during COVID-19: a tertiary centre experience in the first wave of COVID-19

Variable Strategy
Limiting transmission risk Testing patients receiving SACT at the cancer centre
Staff members were deployed to the front of hospital to ask COVID-19 screening questions and check patient temperatures prior to entering
Patients who tested positive for COVID-19 but required an in-person review or were suitable to continue SACT followed a specific COVID-19 pathway within the Cancer Centre (separated from other patients). Patients receiving SACT were treated in a side room by dedicated nursing staff
Visitors
Majority of visitors and relatives were not allowed to attend the hospital with the patients. However, there were several extenuating circumstances including patients receiving end-of-life care and vulnerable individuals
Staff members
Staff members conducted basic measures to reduce risk of transmission including hand hygiene, wearing appropriate PPE depending on the clinical context, social distancing, and self-isolation if they develop symptoms suggestive of COVID-19
Social distancing
Infection control teams helped determine the limit in which the number of people can be in a room, elevator, or waiting area
Consultations Virtual and telephone consultants
There has been significant increase in utilising technology to aid virtual and telephone consultations, limiting the number of potential contacts both the patient and clinician will have. This also allowed ongoing communication with the patient and their relatives during uncertain times throughout the pandemic
Although this may not be appropriate for all circumstances, this was particularly useful for patients well established on treatments or at a particularly high risk of severe COVID-19 due to comorbidities
Deferring follow-up consultations
We extended the duration between follow-up consultations for some patients who were established on their current treatment. This also applied to certain routine follow-up imaging in which there was a low chance that it will impact the current treatment regimen
Outsourcing services Satellite hubs
These were implemented with the aid of ambulance services to provide mobile blood testing facilities. These tests were then sent to the centre and reviewed by the clinical staff
This allowed patients to limit their duration of travel, avoid public transports, and limit contact with others at the cancer centre
Courier services
Patients that are established on SACT can have their medications couriered to their home rather than pick it up at the cancer centre
Treatment prioritisation With recommendations from NICE and expert consensus, treatments were prioritised based on risk–benefit to contracting COVID-19, probability of cure, reducing immunosuppressive states, and availability of resources to deliver these services. These decisions were discussed with the patient and were considered on a case-by-case scenario