Cancer has not and will not stop for the pandemic! Can oncologists stop?
The COVID-19 pandemic has claimed a lot of lives. It has not only redefined the way we live but for oncologists, it has also redefined the way they treat patients with cancer. Dr. Rakesh Reddy Boya, Chief of Medical Oncology, Mahatma Gandhi Cancer Hospital and Research Institute shares his views on the challenges being faced in treating cancer patients.
Cancer patients are known to be at higher risk of infection and mortality from COVID due to immune suppression caused by cancer itself and also its treatment. Various treatment modalities, like say chemotherapy, are likely to decrease the immunity of patients making them susceptible to getting infected and suffer from more severe forms of COVID.
This created a sense of panic, both among patients and treating doctors. Guidelines were issued by many international bodies (ASCO, ESMO, etc) which outlined how to go about cancer treatment during the COVID-19 pandemic. What we oncologists found was that the actual scenario at ground level was much more different. A lot of cancer treatments got delayed. Not just palliative chemotherapy or supportive care, but curative treatment as well, said, Dr. Reddy.
In these cases, COVID may or may not have killed the patient, but cancer has certainly done so. Without timely initiation of treatment most cancers are fatal. Some like leukemia and aggressive lymphomas are fatal within months. These are the conditions that otherwise have high cure rates with proper treatment.
The reasons for poor outcomes in cancer patients in the COVID situation are manifold. Patients were unable to find transport to reach a specialized cancer center (which in India, tends to be centered in few urban locations) due to lockdown. Diagnostics and drugs have gotten delayed because of transport and logistics issues. Patients faced huge financial burdens due to loss of revenue during the lockdown, which had an impact on the ability to bear treatment costs.
These are some of the factors which have restricted oncologists from delivering cancer treatment to patients. “The situation in the hospital itself is far from conducive to do the work that we Oncologists are accustomed to do. We made several changes to hospital practices to deal with the pandemic, some in line with guidelines and some with logic and reason. We asked follow-up patients who have completed treatment to connect through online consultations. We advised a change of chemotherapy protocols to regimens with less potential for bone marrow suppression to preserve the immunity of patients. We advocated for the avoidance of elective surgeries and prolonged regimens of radiotherapy,” added Dr. Reddy.
Treatment for cancers with high potential for a cure was given the highest priority, though delivering care for leukemias became very difficult with drying up of blood banks. Despite that, they managed to treat a good number of these patients and performed bone marrow transplants too. The idea is to balance the risk of exposure to COVID-19 with the risk of progression of the disease. Each case today must be looked at individualistically and oncologists have to customize the treatment to suit the situation.
Oncologists urge patients not to ignore any symptoms and not to delay speaking to a specialist if they suspect cancer. The fear of visiting a hospital should not come in the way of cancer treatment. Patients should use teleconsultation to reach out to doctors. Early-stage cancer (Stage 1 or 2) can progress to late-stage disease, becoming incurable, if prompt action is not taken.
COVID-19 is here to stay and both patients and doctors alike just have to get used to the new normal. For both oncologists and patients alike the new normal requires taking extra precautions. These precautions include the basic ones like wearing personal protective equipment and maintaining adequate distancing between people. Hospitals should prioritize creating a triage area to identify patients with features of COVID before they enter into the main hospital area and creating teams among hospital staff to work in shifts (say, weekly).
Lastly, despite the precautions, infection among health care workers is rampant and oncologists are not left untouched in this regard. Taking care of one’s health has somehow taken a backseat in caring for the patients. Taking back infection to vulnerable people at home, elderly with comorbid conditions, very young children, etc has been a source of great stress apart from the fear of contracting the disease oneself.
“As oncologists, we are used to dealing with tough situations, but the COVID-19 pandemic has added so many additional challenges. Despite the extremely difficult and trying circumstances that prevail, oncologists should make their health a priority, and also focus on mental health. The right kind of mental health support can help build resilience, giving us doctors the ability and confidence to manage the stress created by the COVID-19 pandemic,” concluded Dr. Reddy.
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