UK Clinician information: GenesisCare continues to treat without delay

As the COVID-19 pandemic is changing rapidly, we wanted to keep you up to date with information on our treatment status, centre preparedness and business continuity plans.

Treatment continues as usual and until further notice we are prepared to treat all patients without delay or compromise

GenesisCare remains committed to ensuring that cancer patients can continue to receive the care they need in our centres. Currently all our centres are operating as usual and we are continuing to treat patients without delay.  We will work with referring doctors to adjust patient treatment dates and protocols only for those most at risk patients.

We would like to assure you that GenesisCare is a safe place for patients to receive treatment. At the start of February we implemented a screening process for all patients and visitors and are confident that we have robust measures in place to protect staff and patients. Our approach is being updated pro-actively to respond to the science, official guidance and GenesisCare’s global policy.

We are aware that as the spread of coronavirus escalates and pressure builds in the NHS, some patient’s cancer treatment may be delayed or deferred. We encourage you to continue to refer your private patients to GenesisCare and we will arrange appointments, planning and treatment in a timely manner. A reminder that our private transport option for those patients that require it also helps limit the risk of infection. Our contracted drivers are following strict hygiene processes in response to our guidance.

We are aware several surgical procedures are being rationed or postponed in the NHS to understandably manage capacity. Now more than ever we need to support the NHS to manage scarce resources. Please ensure MDT treatment options include MRLinac as a non-invasive alternative for radical treatment including prostate patients that might be appropriate for all treatment options including prostatectomy or radiotherapy using the 5 fraction MRLinac protocol. Please contact either of us or your local Referrer Engagement Manager to get your patients access to this treatment option.

Diagnosis and treatment

In order to ensure patients are able to quickly access the diagnostic tests and treatment they need, we are continuing to run One Stop clinics for breast and prostate patients in our Maidstone, Milton Keynes, Oxford and Windsor centres. Cambridge One-Stop clinics will go-live in April and Windsor Breast clinics will begin in May.

NHS Patients 

We are also working on ways to support NHS patients, both by directly working with Trusts close to our centres and as part of the Independent Healthcare Providers Network, of which we are a member.  Should we start to treat NHS patients, we will keep you informed to ensure you are aware of pathways, procedures and treatment protocols. At the moment we are focused on supporting private patients and managing footfall to ensure we are limiting risk across our network in order that we can continue to treat without interruption.

Patient clinics and on-treatment reviews 

We believe that all patients should have access to their consultants, prior to and during treatment as part of their care.  However, we request that all patient consultations are now conducted by video conferencing or telephone to reduce footfall in centres.  Should you need to be physically present for a patient treatment, consultation or test, please liaise directly with the respective Centre Leader. The Centre Leaders will support in providing secure video conferencing and ‘how to’ guides for both yourself and patients to ensure the virtual consultation goes as smoothly as possible.

On-treatment reviews conducted with our radiographers will be done via telephone rather than in person. Any patient related concerns will be raised to the patient’s consultant as per our standard process.

Patients attending our centres

We are advising patients to avoid bringing companions to the centre unless it is absolutely necessary to support their care.  In this instance, patients are advised to limit this to one companion only.

Treatment planning / contouring and plan approvals 

We have asked our dosimetry and physics teams to work remotely to reduce staff in our centres as this staff group have remote access.  Treatment planning activities will be completed remotely for all doctors with the dosimetrist or physicist from your treatment centre liaising with you to make this possible.  They use remote shadowing software with the capability to screen share and take control over your session. For more simple cases virtual simulations can be used which is used by a large number of our current referrers.

Updated RCR Guidance 

We have also reviewed the updated guidance which has been issued by the Royal College of Radiologists (RCR) on Friday 13th March 2020.  The RCR guidance is detailed in bold below:-

For patients who are self-isolating, we will discuss the risk / benefit of attending for treatment with our local infection control team, considering the latest government guidance

  • GenesisCare is a safe place for patients to receive treatment. Our patients benefit from our smaller departments and our ability to provide remote working for many of our processes.

When capacity is limited, providers consider evidence-based shorter fractionation schedules and deferring radiotherapy for some groups.  

  • GenesisCare is committed to maintaining global best practice and will maintain established protocols without the need to move short fractionations unless the referring doctors believes it is clinical appropriate and it is approved by GenesisCare CAT review.

For patients with suspected or confirmed COVID-19 infection, consider cohorting on one machine or in one part of the department. 

  • As we typically operate in single linac departments we try not move patients to an alternative linac in a beam matched adjacent site as the RCR guidelines stipulate. We are however, able to take special measures to allow treatment of these patients. This would mainly cover patients where a treatment gap is not possible such as Category 1 patients.  We will continue treatment in as safe a way as possible.  They will be treated at the end of the day, in an empty department with only 2 treatment radiographers present. Staff will wear the advised PPE equipment and clean the treatment area afterwards.

Where gaps in treatment occur, try to compensate as per the RCR guidelines. We recognise that despite this, gaps in treatment may affect outcomes

  • We will follow RCR guidance on treatment gaps and offer radiobiological gap calculations to try to ensure that treatment is as close to the initial intent as possible. As commented above, currently we does not expect treatment gaps will occur but will update if operational downtime becomes an issue.

SACT treatments

  • Our recommendation is that all our clinicians consider adding GCSF support to SACT regimes on iQemo for highest risk of causing neutropenic sepsis, including anthracyclines, taxanes, platinum treatments and hematological regimes.

Continued service

We will continue to monitor the evolving situation and continue to follow both government and RCR guidelines. Any updates will be clearly communicated with the patients and consultants.

We would like to reassure you that we continue to put our patients care at the centre of everything we do and provide our high standards throughout this situation.

James McArthur

General Manager, UK

Penny Kechagioglou

Chief Medical Officer, UK

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