The pandemic has spread rapidly worldwide, making the already major cause of morbidity and mortality: cancer, acutely worse.
By Dr. Tejinder Kataria
The novel coronavirus disease or the COVID-19 pandemic initiated a national lockdown in India and rest of the world, bringing up massive challenges for the treatment of cancer patients. The pandemic has spread rapidly worldwide, making the already major cause of morbidity and mortality: cancer, acutely worse. On an average cancer patient visits to hospitals have substantially declined by 64% after the outbreak. The decisions to delay the diagnosis and treatment for cancer, under the duress of the pandemic will have grave consequences for cancer mortality for years to come. Medical science has always adapted and evolved to overcome different challenges and we wish to do so in the age of COVID too.
Those who have recently been diagnosed with cancer, or are in the midst of cancer treatment, are facing disruption for all but the most urgent procedures as a recent report of ‘Cancer Care Delivery Challenges Amidst Coronavirus Disease – 19 (COVID-19) Outbreak’. The report published in the journal of Asian Pacific Journal of Cancer Prevention indicates that cancer patients are more susceptible to coronavirus than individuals without cancer.
Treatments like surgery, chemotherapy and immunotherapy cause a great amount of stress on the normal functions of the body and may worsen the symptoms of the Coronavirus. Radiation is a localized treatment and hypo-fractionated therapies (short protocols) are available for cancer patients to have treatment without major systemic effects.
Future of Cancer Treatment
The future of cancer treatment, in the post COVID-19 era, will be dictated by reducing the in-person visits of patients by having a pre-consult and follow up consults through the telemedicine portals using either audio or video facility. Immunotherapy can enhance the cytokine surge in the body and this is also a complication with COVID infection, hence a decision to administer immunotherapy needs to be taken very cautiously. If a major surgery or chemotherapy can be delayed by starting with either Radiation therapy or Hormone therapy in the multimodality treatment of a patient, the sequence of treatment can be changed without causing a detriment in the outcomes for cancer care.
The cancers where there can be a hope to consider radiation therapy as first line cancer treatment during COVID pandemic are prostate and breast cancers with estrogen receptor positive disease, especially for patients more than 60-65 years of age. Other cancers are Head & Neck cancer and cancer of the cervix. For the radiation therapy short-high dose protocols like Stereotactic Body Radio Therapy (SBRT) or single fraction treatments like Stereotactic Radio Surgery (SRS) are preferred and have had acceptable outcomes, with minimum hospital visits for the patients.
The advances in Tele-health and remote consultations started during COVID pandemic can be a facilitator for the patients and their families to reduce the travel over long distances, stays in hotels and guest houses, having outside food and also can be economically beneficial to the society by reducing the financial burden for patients with cancer in a large country like India.
Lastly, getting diagnosed with Cancer at any point in life is a life-changing moment for the person, their family and even the health-care professionals. While we all pray and hope for the COVID-19 pandemic to subside and/or for a vaccine to be found, we must not forget that there is still no cure for cancer if not diagnosed & treated in an early stage. Prevention and early treatment are still the best defence for it. So it is vital for the government – national, state and local – to take all the necessary actions to ensure that cancer patients continue to receive the attention, quality of care and treatment that they need to ensure the best chance of survival.
The columnist is Chairperson Radiation Oncology, Medanta Cancer Institute, Medanta – The Medicity. Views expressed are the author’s own.