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Cancer treatment another casualty of COVID-19
Dr Namita Pandey offers her perspective on cancer care during the pandemic
Data show that patients admitted with COVID-19 – related illnesses have a mortality rate of 14.6 percent among the cohort of patients who had cancer compared to those who did not
The global outbreak of COVID-19 has brought about an unprecedented level of disruption to healthcare delivery models . In the context of oncologic or cancer care , clinicians and patients face both the risk of exposure and the potential of transmitting the virus to others , including family members .
Inherent to the diagnosis itself , cancer comes with a burden of uncertainty : prognosis , treatment options and their outcomes , toxicities , and personal and family coping with anxiety . Adding a global pandemic to this milieu of human agony brings inflated levels of uncertainty , resulting in additional distress felt by the patient and caregivers equally . During a pandemic , these unpredictable factors can include how patients respond to treatment , the chance of infections due to treatment-related immune suppression , or risks of long-term recurrence , among others .
Data show that patients admitted with COVID-19 – related illnesses have a mortality rate of 14.6 percent among the cohort of patients who had cancer compared to those who did not . Given these outcomes , clinical stakeholders are rapidly developing strategies to safely deliver oncologic treatment with minimal exposure of the patients and the healthcare providers . However , these approaches are in their nascency , while the traditional face-to-face model of care remains significantly altered . As a result , considerable uncertainty still pervades the delivery of cancer treatment to every patient .
Patient-centred innovations , such as telehealth video consultations which have been under discussion for decades , have suddenly gained momentum . Concurrently , clinical investigators continue to explore real-world evidence to understand the implications of this disruptive event in oncology .
The global explosion of COVID-19 patients packing hospital ICUs has impacted the management of cancer patients who sometimes require equally urgent care . It ’ s well recognised that the virus is more severe in elderly patients or patients with co-morbidities . Numerous recommendations have been made for cancer management in the COVID-19 pandemic context , and they vary depending on the number of cases in different countries and available resources . For example , the healthcare system has been modified worldwide to limit human contact , which has affected the delivery of routine cancer care and supportive services . The American College of Surgeons recommends postponing elective surgeries if there are too many COVID-19 cases in the concerned institution . The risk of contracting COVID-19 infection in an otherwise healthy patient with curable cancer outweighs the benefit of cancer treatment . Transition to telemedicine and video consultations has somewhat bridged the gap for outpatient visits , but the challenge of delays in cancer screening due to the pandemic continues .
Another impact of the virus is that the sudden lack of resources and the need to divert workforce resources towards the pandemic has caused hospitals to postpone elective surgeries or limit inpatient admissions .
At the same time , enhanced infection control measures , including viral testing and universal use of personal protective equipment , have placed an increased burden on available medical resources . Reallocation of medical personnel to COVID-19 wards has reduced the number of available oncologic specialists . Additionally , the availability of operating rooms and hospital beds has also decreased . To cope with these changes in resource availability , hospitals have issued a number of mandates that have resulted in cancer detection delays . These include rescheduling of non-emergency appointments , procedure postponements , and imaging ( i . e ., mammograms ) schedule alterations .
The present situation primarily affects the ongoing treatment of cancer , including surgery , chemotherapy , and radiation therapy . Nationwide lockdowns have also limited patients ’ ability to commute to their healthcare facilities . The concern for otherwise healthy patients with curable cancers who require timely therapy is that the risk of contracting COVID-19 may outweigh the benefits of cancer treatment . A number of patients have expressed apprehension about exposure from healthcare facilities and public transportation . These risks are evident to both patients and medical personnel . Both , therefore , need to consider the risk-to-reward ratio in treatment initiation and management .
Another potential concern is that delays in cancer diagnosis and initiation of care will result in thousands of excess cancer deaths over the next several years . As a result , several international and national organisations have published consensus guidelines for the management of breast cancer during the pandemic outbreak . These guidelines aim to develop
70 AUGUST 2021 GlobalHealthAndTravel . com