The COVID-19 pandemic has disrupted the entire gamut of cancer care in India, including delaying diagnosis and treatment, and halting clinical trials.
The diagnosis and management of cancer are time-sensitive and are likely to be substantially affected by these disruptions. In response, healthcare systems are rapidly reorganizing cancer services to ensure that patients continue to receive essential care while minimizing exposure to the COVID-19 infection.
According to a Lancet Oncology study, India reports about 1.3 million cancer cases annually and almost eight per cent of total deaths. This is likely to increase in the next 5-10 years due to delay in diagnosis and treatment owing to the COVID-19 pandemic.
COVID-19 exposed cancer care vulnerabilities
The COVID-19 pandemic has exposed several vulnerabilities and adversely affected cancer care. Lockdowns and restrictions on movement during the pandemic, along with patients’ fear of contracting COVID-19, prevented patients from travelling to cancer centers for diagnosis, treatment, and follow-ups.
Secondly, some cancer centers were converted to COVID-19 care facilities with the redeployment of hospital beds and staff, reducing the resources available for cancer care. This was further aggravated by scarcity of personnel in hospitals due to infection, quarantine.
Thirdly, treatment regimens for cancer were modified or de-escalated to enhance the risk of an anticipated increase in mortality from COVID-19 in immunocompromised patients. Poor access to palliative care and opioids, which existed even before the pandemic, has been aggravated in the past two years.
Across the cancer centers, major reductions were seen in new registrations, outpatient services and major surgeries. One important adverse impact has also been on the drastic reduction in the education and training sessions for all oncology.
Cancer patients at higher risk of contracting COVID-19
Patients with cancer have worse mortality when infected with COVID-19 compared to otherwise healthy people, and that’s why they belong to the high-risk populations that need to be protected from infections. This has created an issue when it comes to the continuation of cancer treatment in patients infected with COVID-19, as oncologists have to balance the risk of cancer progression with that of post-COVID-19 outcomes.
The fact that cancer patients are more vulnerable to COVID-19 infection and its complications have resulted in new challenges in managing cancer care delivery systems. Due to the pandemic, there has been a delay in chemotherapy and radiotherapy and thus the stage of cancer has further worsened.
Apart from the oncology issues, even primary health care in rural areas took a hit, as most of the ground-level healthcare workers were directed toward the pandemic care, leaving none for cancer-screening activities. Cancer patients and healthcare workers need special attention during these trying times; however, calculating risk-benefit ratio considerations is becoming equally important.
Reducing burden on cancer centers
In order to reduce the burden of cancer care in India, some useful strategies should be adopted. Segregating hospitals into COVID-19, enhanced infection prevention and control practices, and increasing reliance on tele and video consultations are some of the strategies that should be applied in order to ease the cancer burden in the country.
Screening programmes can be modified by using techniques that require minimal interaction such as physical examination for breast and oral cancers and visual inspection for cervical cancer. Access to medicines should be improved by arranging for delivery of these drugs to the patient.
The COVID-19 pandemic has exposed the lack of equitable cancer care across the nation. Advanced therapies are available only at a few government-run institutions or private institutions. Thus strengthening the existing cancer care network with private-government partnership is essential to ensure that everyone has access to appropriate treatment irrespective of geographic location or ability to pay.
Though cancer therapy has advanced significantly, the need for a robust system that helps reduce the time from diagnosis to treatment still exists. Efforts in this direction will ensure that cancer is detected at a stage where it is largely curable.
Lastly, eradicating the stigma around the condition, creating awareness, and providing support will ensure that the treatment is completed successfully.
The author is Senior Consultant, Surgical Oncology, Fortis Hospital, Noida. Views are personal
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