The COVID-19 pandemic is a serious global health threat that has exceeded 11.8 million cases and over 540,000 deaths, as of July 8, 2020. The pandemic has posed several challenges for radiation oncologists which require a strategic approach to minimize their patients' exposure to the virus, without compromising disease outcomes. International societies and experts have endorsed specific recommendations for breast radiotherapy, with the intention of optimizing resource allocations. Nonetheless, we recognize that significant heterogeneities in practice may exist, causing barriers for uniform care delivery.

We request your participation in an international, clinical case-based survey that has been designed with the assistance of breast radiation oncologists all over the world including North America, South America, Europe, Asia and Africa. Our study aims to understand how the international practice patterns of radiation oncologists treating breast cancer patients have changed during the COVID pandemic, compared to pre-COVID era. We may distribute this survey at a later time to assess for longitudinal changes in practice patterns. With the information gained from this study, we seek to improve upon the adoption of evidence-based rapid guidelines intended to inform breast radiation oncologists about their treatment-making decisions.

Participation in this study is entirely voluntary and will not affect your professional standing. All responses are anonymous, will be kept confidential and Protected Health Information is not collected.

Thank you for your participation. If you would like to speak with someone not involved in this research (Protocol No. 2020P001416) about your rights as a research subject or any concerns or complaints regarding this study, contact Mass General Brigham Human Research Committee at 857-282-1900.

On behalf of the Harvard Breast Radiation Oncology Group and International Collaborators,

Jennifer R. Bellon, MD

Dana Farber Cancer Institute

Email: Jennifer_Bellon@dfci.harvard.edu

Phone number: (617) 632-3591

Alice Y. Ho, MD, MBA

Massachusetts General Hospital

Email: Alice.Ho@MGH.HARVARD.EDU

Phone number: (617) 724-1160

Dr. Jean-Phillippe Pignol - Dalhousie University, Halifax, Nova Scotia

Dr. Icro Meattini – University of Florence, Florence, Italy

Dr. Orit Kaidar-Person - Sheba Tel Hashomer, Ramat Gan, Israel

Dr. Skye Hung-Chun Cheng – Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

Dr. Chikako Yamauchi – Shiga General Hospital, Japan

Dr. Charlotte Coles – Department of Oncology, University of Cambridge, Cambridge, United Kingdom

Dr. Philip Poortmans – Iridium Kankernetwerk and University of Antwerp, 2610 Wilrijk-Antwerp, Belgium

Dr. Gustavo Nader Marta - Hospital Sírio-Libanês, Sao Paulo, Brazil; Instituto do Câncer do Estado de São Paulo (ICESP) - Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil

Dr. Duvern Ramiah – University of the Witwatersrand Donald Gordon Medical Centre, South Africa

Dr. Anna Kirby – Royal Marsden NHS Foundation Trust and Institute of Cancer Research, and UK President-Elect, European Society for Radiotherapy and Oncology

Dr. Tarek Hijal – McGill University Health Centre, Montreal, Quebec

Dr. Joseph Isern Verdum – Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

Dr. Yvonne Zissiadis – Genesiscare, Australia

Dr. Birgitte Vrou Offersen – Aarhus University Hospital, Denmark

Dr. Jee Suk Chang – Yonsei Cancer Center, South Korea (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea)

Dr. Youlia Kirova - Department of Radiation Oncology, Institut Curie, Paris, France

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