New Delhi: The rapid spread of COVID-19, combined with an unprecedented, near-complete global lockdown has become a major challenge for providers in all areas of health care delivery, including cancer centres.
Amid the pandemic, when all hospitals and health care centres are busy treating COVID-19, patients with cancer are worried and are facing hardships as their treatment and surgeries have been delayed. This has become a major concern from the perspective of the country's health scenario as studies highlight that cancer patients are at greater risk of contracting coronavirus that causes COVID-19 owing to their compromised immune systems.
On the other hand, there are thousands of cancer patients who are treated with radiation therapy and chemotherapy and reports have suggested cancer patients who are undergoing treatment are at increased risk from the virus.
ETV Bharat spoke to Dr Tapaswini Pradhan Surgery Oncologist, Fortis Hospital in detail about COVID-19 impact on cancer patients.
"Cancer patients are a highly vulnerable group and according to studies published in The Lancet Oncology they are at two-fold higher risk of contracting COVID – 19 and a 5-fold higher risk of developing a severe form of the disease", said Surgical Oncology Senior Consultant of Fortis hospital, Dr Tapaswini Pradhan.
"Studies have shown that surgeries when performed on patients who turn out to be COVID-19 positive later, have a 28 – 32% risk of life-threatening complications and mortality to the tune of 28%. Hence every patient should be counselled", she added.
"Most are immunocompromised either because of the disease per se or become so with the treatment which includes chemotherapy/radiotherapy. Cancer takes a heavy toll on the body and patients become nutritionally depleted. Anaemia and hypoproteinaemia further compromise the immune system. Also, half of all of the cancers in men and a quarter of cancers in women are tobacco-related and tobacco in itself weakens the immune system. Most solid cancers occur in a higher age group who also have associated co-morbidities – hypertension and diabetes, etc. thereby making them even more vulnerable.
"There is a significantly higher risk of severe events - death or ICU admission in the cancer patient's vis-a-vis general population (39% vs 8%)", Dr Pradhan said.
When asked whether the treatment should be delayed, she said, "There is no direct evidence to support changing or withholding chemotherapy, targeted therapy and immunotherapy in cancer patients. The clinical decision should be individualised taking cancer recurrence into account if therapy is delayed, modified or interrupted. Some may have to switch over from iv chemotherapy to oral drugs or some may consider infusion at home".
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She added, "Elective surgeries for cancer patients can be rescheduled if possible. But oncologists should look into the potential harm of delaying the needed surgery. Cancer patients undergoing radiotherapy, or who have been planning for it, the decision to postpone would be keeping in mind the risk/benefit assessment".
She underlines that one will have to assess the potential benefit of any oncological procedure over cancer recurrence / overall survival vis-a-vis the potential risk of death from COVID-19. "Elective surgeries on a COVID positive patient should be put on hold till there are two negative COVID tests spread over 24 hours. Only emergency surgeries when warranted may be performed on the positive patients", Dr Pradhan pointed out.
Later, the expert suggested some policies and strategies which includes- Teleconferencing to be encouraged; all precautions to be taken for all patients visiting the hospital. Every individual stepping into the hospital should be considered as a potential carrier for the virus; adequate protection for the healthcare workers should be provided by the hospital; clear cut guidelines for the management of the COVID patients should be laid down for all the departments to avoid confusion and discrepancies in the treatment protocol.
To boost the immune system of the cancer patients, the doctor recommended consumption of supplements such as Vitamin -C, Vitamin-D, Zinc and plenty of fresh fruits and vegetables which has shown effective results in nourishing the immune system.
