COVID-19 pandemic has led to 5.6 million deaths worldwide. It has burdened the health care systems along with a significant decrease in the capacity to treat non-COVID illnesses.
Cancer is a complex disease and treatment outcomes are dependent on the timing of diagnosis and timing of the treatment provided. Many oncology centres have restructured their services to create COVID-19 units. There have been reductions in number of doctors and nurses due to infection, quarantine, or as a deliberate staff-sparing strategy. Access to health-care facilities has been restricted due to travel restrictions, COVID infection of patient or family members and unwillingness of patients to visit hospitals because of fear about exposure to COVID infection. This has led to possible delays in cancer diagnosis and management which are known to affect the treatment outcomes.
Patient with cancer are more susceptible to COVID-19 infection. According to a recent publication, it was found that the SARS-CoV-2 viral load is an independent predictor of the in-hospital mortality of patients with cancer. Patients with cancer have a weakened immune system and are often comorbid with type 2 diabetes or cardiovascular disease, which leads to the overall poor health status and increases their susceptibility to COVID infection. This makes it more challenging to predict the disease progression and to manage disease symptoms in cancer patients. Also, most chemotherapy drugs are cytotoxic, which inhibit the immune systems and predispose the body to an immunosuppressive status, making cancer patients more susceptible to COVID-19 infection and developing a severe disease.
According to a multi-institutional study from 41 oncology centres published by National Grid of India, it was identified that there was 54% decrease in the number of new patients registered, 46% decrease in follow up visits, 36% reduction in hospital admissions, 37% reduction in outpatient chemotherapy, 49% reduction in major surgeries, 52% reduction in minor surgeries, 23% reductions in radiotherapy and 43% reduction in the radiological diagnostic tests during the peak COVID times. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months.
All aspects of care, including screening, diagnosis, treatment, palliative care, and follow-up were reduced during the pandemic. This will result in delayed diagnosis, and suboptimal treatment for a proportion of patients who would have been diagnosed with cancer in this period. According to the study, this delay in cancer diagnosis and treatment can possibility become a serious public health problem in the next few years.
Oncology centres and societies should make a separate guidelines for treatment of cancer patients in COVID affected regions and delay in diagnosis and treatment must be avoided. Physicians treating patients with cancer should follow evidence-based treatment guidelines to optimise cancer management while simultaneously balancing the risks of SARS-CoV-2 infection and measures like teleconsultations, video consultations and separating non-COVID and COVID corridors in the hospital might help in decreasing the treatment delays to these patients.
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(Dr Pradeep Jain, Director, GI & HPB Onco Surgery, Fortis Cancer Institute, Shalimar Bagh, Delhi)
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