"The C in cancer has been eclipsed by the C in COVID. So a demon like cancer has been pushed back by the other demon like COVID-19."Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
Two years in and it's becoming clearer than ever that the fault lines of COVID-19 run deeper than we thought. COVID-19 doesn't just impact those infected, but its ripples have been disrupting continuum of care other chronic illnesses—sometimes a matter of life and death.
A study, for instance, published in the medical journal Lancet Oncology, conducted across 41 cancer centers in India found that between March and May of 2020, new registered cancer patients decreased by 51 percent.
Among the many challenges faced by cancer care professionals, the delay in patients seeking treatment is 'the most heartbreaking,' oncologists tell FIT.
The Impact of the Pandemic on Cancer Care
Key findings from the Lancet study:
Between 1 March and 31 May 2020...
Follow-up visits of cancer patients decreased by 46 percent
Hospital admissions decreased by 36 percent
Outpatient chemotherapy decreased by 37 percent
Number of major surgeries decreased by 49 percent
Pathological diagnostic tests went down by 38 percent
Palliative care referrals was down by 29 percent
"Cancer screening was stopped completely or was functioning at less than 25 percent of usual capacity at more than 70 percent of centres during these months."Study authors
The situation hasn't improved since.
"In our own experience, we used to see 200 cases of breast cancer at the Apollo Hospital once a year, and out of them 50 percent would be early where I would do only breast conservative surgery," says Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi.
"Now we have seen only 100 patients in the last one year. (Which means) some of them are still sitting at home with the cancer in their body," she adds.
"Out of this 100, I have done breast conservation in 20 people. 80 have been advanced. we cannot do breast conservation in late stages. They end up losing their breast, and more people would be requiring radiation at the same time."Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
Explaining this further, Dr Tejinder Kataria, Chairperson, Radiation Oncology, Cancer Institute—Medanta, Gurugram, tells FIT, "the patients who were having symptoms could not come for their checkups, or have the diagnosis made, because of the travel restrictions that were put in at the time. That was one part."
"Second was the patients who were already on treatment had a difficult time commuting to and back to the hospital. Third is that the other state migration," she adds.
Some patients, she says, waited for over six months to even get diagnosed, which is enough time for the cancer to be too far gone.
"The doctors were very upset when the patients were coming in such late stages. At this point, a curable patient becomes only treatable, or a treatable patient becomes non curative."Dr Tejinder Kataria, Chairperson, Radiation Oncology, Cancer Institute—Medanta, Gurugram
Delaying Treatment: A Ticking Time Bomb
Cancer, she goes on to say is curable if caught early. Especially in the case of some cancers like breast cancer, which she explains, "can be cured 90 percent of the time if diagnosed early."
The key word, however, is early.
Another analysis of thirty-four observational studies published in medical journal BMJ found that, every month's delay in treatment — whether surgery, radiation therapy (such as chemotherapy or immunotherapy), or medication— led to an increase of 6 percent to 13 percent in the risk of fatality.
Dr Sarin goes on to talk about one of her patients.
"She told me, 'I have it (lump in the breast) for the last three years, and first year I didn’t want a chemotherapy and it became big. And then it was COVID so I didn’t come.” So three years and it’s gone to the point of a 10 cm wound area, and she is living with it."Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
"Of course we will treat her, but chances of having a normal life are few," she adds.
"One week is alright, two weeks is okay, three weeks is okay, but you can’t be waiting for three months and three years. It’s not a sensible thing to do," Dr Sarin reiterates.
'Come Rain or COVID, Don't put off Testing'
Cancer patients, especially those on immunosuppressants have been categorised as high-risk from the beginning of the pandemic.
The fear of catching COVID is also one of the main reasons that has been keeping patients from going out and getting their treatment, or even diagnosis.
"Women that are coming in now have been saying, “Madam we are having these lumps for the last one year, and we did not come because of COVID.”Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
But doctors that FIT spoke to report that in their experience, their cancer patients who got covid didn't develop any more severe illness than others.
"In my observation not more people who have cancer and COVID have died than a person who does not have cancer and got COVID and died. So the mortality is not higher from the COVID in cancer patients as it is COVID in normal people."Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
Dr Kataria has also made similar observations, saying, "So fortunately for us, we've not had a more difficult time with the (cancer) patients who got COVID. And that is what the data is showing from across the countries in the world. Also, we have not seen an increase in the complications because of the COVID and the additional treatment utilization (for cancer patients)."
According to Dr Kataria it could be that the low natural immune response of the cancer patients kept them from developing complications and symptoms that are a result of aggressive immunogenic response like cytokine storms.
Both Dr Kataria and Dr Sarin, however, emphasise on keeping a closer observation of COVID positive cancer patients and delaying surgeries and chemotherapy until they've tested negative.
"There is a 5 percent mortality with COVID, and a 50 percent mortality rate with cancer. So, obviously, one should not shy away, and putt off check ups because they are scared of getting COVID."Dr Ramesh Sarin, Senior Consultant, Surgical Oncologist, Indraprastha Apollo Hospital, New Delhi
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