COVID-19Feb 21IssueOpinion

Impact of COVID-19 on Cancer Care

How cancer universe was affected by the pandemic

Dr (Col) R Ranga Rao, Chairman, Paras Cancer Centre, Paras Hospitals, Gurugram

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The coronavirus pandemic and the subsequent lockdowns have impacted not only cancer care but also cancer research, in India and the world alike. The initial period of uncertainty brought new challenges for cancer patients, disruption of the delivery of cancer treatment and the continuity of cancer research. Many elective cancer surgeries were cancelled to redirect resources and healthcare staff to manage the coronavirus pandemic, as well as for the fear of corona infection.

Simultaneously, after a short gap, the addition of telemedicine, artificial intelligence and digital healthcare services happened in a revolutionary manner across the world, to maintain the continuous healthcare services to all concerned patients as well as to help the patients and people to be advised promptly about the corona infection. This helped the patients to curtail the spread of the virus, and advise about their medications from the comfort of their houses. For cancer patients, the challenging and unintended times began for those who didn’t know that they are going through cancer.

Various studies have suggested that the pandemic led to a roughly 80 per cent drop in routine screening appointments that could catch new cancers in March and April. Since the cancer screening can’t happen virtually, the cases of breast, colon and cervical cancer also increased. Most of the screenings for above-mentioned cancer require an in-person procedure like a colonoscopy (for colon cancer), mammogram (for breast cancer) or a pap smear (for cervical cancer). There has been a tremendous decline in the number of tests to screen for cervical, breast and colon cancer by 85 per cent or more after the first COVID cases were diagnosed in India. Delays in cancer screenings and treatment are expected to lead to more than 10,000 additional deaths from breast and colorectal cancer over the next decade.

The pandemic has taken a toll

The COVID-19 pandemic has no doubt left a negative impact on cancer care. It has been found that nearly 50-80 per cent of people in treatment for cancers have experienced some delay in care due to the pandemic. However, as we are getting back to the normal many healthcare centres are once again encouraging patients to come in for routine care. Many have implemented safety protocols (like limitations on visitors, getting rid of waiting rooms and mandatory COVID-19 testing for certain patients and staff) that make it safe for most patients to come in for screening tests. Doctors are also asking outstation cancer patients, who are in the advanced stage, to get their chemotherapy done from their nearest hospital just in case travelling is an issue.

COVID-19 was harsh on cancer patients

COVID-19 has a dangerous consequence of having an overaggressive immune response known as a ‘cytokine storm,’ Dr (Col) R Ranga RaoChairman, Paras Cancer Centre, Paras Hospitals, which can damage lung and other tissues. Patients with cancer are treated with immune-stimulating therapies such as immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapies and bi-specific T-cell engagers (BiTEs) are at the risk for complications if the immune response produced by these therapies results in an attack on normal, healthy tissue. Patients treated with CAR T-cell therapies and BiTEs, in particular, can develop a side effect known as cytokine release syndrome, which is similar to the cytokine storm in patients with COVID-19.

Researchers have theorised that COVID-19 could aggravate cytokine release syndrome in patients treated with certain immunotherapies, but studies have not shown that this is happening. During COVID, old patients couldn’t come for a check-up which resulted in the delay in diagnosis and treatment. New cancer patients could not get into the hospital for getting their check-up done as many government centres were either shut or converted into COVID ward.

Impact on cancer research

To limit the spread of COVID-19, many laboratories have developed new policies so that a limited number of lab workers can enter. This also resulted in putting many studies on hold. Many projects supported by private philanthropy groups faced funding issues. Drastically decreased donations to cancer-focussed philanthropic organisations have also been witnessed. A report suggests that the American Cancer Society expects a $200 million decrease in donations this year and has not been able to accept applications for research grants for the fall grant cycle. This is not all.

Some cancer centres also put a hold on enrolment on clinical trials entirely during the height of the pandemic. A survey of clinical investigators in March found that nearly 60 per cent of respondents had halted screening and/or enrolment in certain trials, and that half of their institutions had ceased collection of blood and other tissue for research purposes.

Despite these challenges, investigators have come up with a variety of ways to adapt to challenging circumstances so that trials could continue. These include leveraging telehealth, e-signatures for trial documentation and shipping oral medications and allowing tests to be done even outside the lab.

Lessons learnt from COVID

Cancer patients and caregivers, by necessity, have to become adept at living in limbo. Will cancer come back? Will, there be another epidemic or pandemic or something that can change? We don’t know. ·

Be prepared, not panicky

It’s good to educate yourself, but you want to find the right resources and avoid stories that feed into the panic. The more informed you are, the more you’ll feel in control of what’s happening. Stay connected with others — and yourself.

No matter what happens, one must always remain in touch with their loved ones and own too. It’s easy to become isolated and lonely. But that makes your weak both mentally and physically. We can’t control what’s happening right now, but we can control how we respond to it. Things may seem haywire but every day there’s something to be thankful for. Find what makes you happy and focus on that, whether it’s family or friends or the sound of birds chirping outside.

The healthier protocol is the need

Not only people, even hospitals and healthcare centres have become more aware of healthier protocols. Wearing a mask and good sanitization has also become the norm. People have understood the severity of infectious diseases and started following healthy practices.

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