Cancer care takes a hit during lockdown

Cancer treatment took a massive hit in April and May, when roughly 70% of patients could not access life-saving surgery and treatment, according to data from some of India’s largest super-speciality hospitals.

Cancer surgeries in April and May in the aftermath of the lockdown enforced from March 25 to curb the spread of the coronavirus disease pandemic were one-fifth the surgeries performed in the corresponding period in 2019. Cancer services declined by 50% in April and May compared to the same period last year, shows data from leading private hospitals for cancer across India.

Even after the lockdown was relaxed gradually, the fear of Covid-19 infection is keeping some cancer patients away from hospitals. Those who seek treatment don’t get it because of health systems prioritising coronavirus disease treatment over all else, leading to lifethreatening delays in diagnosis and treatment.

In February, a 52-year-old man who requested anonymity developed a small swelling on the left side of his neck, but it took six hospital visits and twoand-a-half months for him to be diagnosed with cancer. By the time his treatment began at Max Super Specialty Hospital at Saket in New Delhi in June, his tumour was oozing blood and he had lost 10kg, which brought his weight down to 61kg.

“Most hospitals turned us away saying they did not have beds free. Two hospitals said no to dressing my wound because by the end of May, I had developed fever before I was diagnosed with lymphoma,” the patient said after undergoing a second round of chemotherapy at the hospital on June 18.

At least 51,100 live-saving cancer surgeries were cancelled in India from the end of March to the end of May, estimated Covidsurg Collaborative, a research network of surgeons and anaesthetists in 77 countries, including India, which published its findings in the British Journal of Surgery in May.

“Cancer patients are among the most vulnerable as they need early diagnosis and uninterrupted and often hospitalcentric treatment for good outcomes to prevent high morbidity and mortality. He arrived here with a more than 10cm lymphoma, which is cancer in infection-fighting cells of the immune system. A colleague’s father was diagnosed with lung cancer on March 20, but missed treatment for two-and-a-half months. Now his lung cancer is at an advanced stage,” said Dr Harit Chaturvedi, chairman, cancer care, and director and chief surgical oncologist at Max Healthcare.

One out of eight men and one in nine women in India has probability of developing cancer in their lifetime (0-74 years), according to the Indian Council of Medical Research-national Centre for Disease Informatics and Research (ICMR-NCDIR), Bangaluru, which implements India’s national cancer registry programme through 36 population-based registries and 236 hospital-based registries across states. It estimated there were 1.45 million new cases of cancer diagnosed in 2016, which will double in the next 20 years.

Cancer killed 813,000 people in 2016 and accounted for 8.3% of total deaths in India that year, according to the ICMRLED India State-level Disease Burden Initiative study on cancer published in the journal The Lancet Oncology in 2018.

“There is preliminary evidence that cancer surgeries and treatment have reduced post lockdown, but the national registry will have mature date on the impact of this disruption on cancer outcomes after a year, where we can analyse data systematically to say whether delays in treatment have increased death,” said Dr Prashant Mathur, director, ICMR-NCDIR.

Children with cancer are particularly vulnerable. “Early results suggest that of the 10 children who would normally be expected to be diagnosed and treated for their cancer, six are no longer reaching that stage and hence missing on critical treatment, which will lead to significantly increased loss of life,” said Dr Ramandeep Singh Arora, paedicatric oncologist and principal investigator of an ongoing national study on the effect of Covid-19 on childhood cancers in India.

Studies show that if patients get timely treatment, outcomes don’t get affected even in patients who develop cancer and Covid-19. A study published in The Lancet last week that analysed data from patients with Covid-19 and cancer in the UK and the US found the new coronavirus infection does not affect cancer treatment outcomes. The UK Coronavirus Cancer Monitoring Project prospectively collected data on 800 patients and found “no interaction between anticancer treatments within four weeks before testing positive for Sars-cov-2, and Covid-19 morbidity or mortality was found”. The US Covid-19 and

Cancer Consortium analysed prospectively collected data from 928 patients and found no increase in 30-day mortality associated with anti-cancer therapy.

“In the beginning of the pandemic, all our resources were understandably directed there, but now there is an urgent need to strategise with a calm head. The government must not just restore all services for urgent treatments, emergency care and cancer, dialysis etc, but must also strengthen policies and communicate its initiatives to restore public confidence. We must deploy 50% of health care resources to Covid, and the rest to non-covid {cases},” said Dr Chaturvedi.

“Delayed treatment is likely to lead to cancer progression to late stages, so we need resume services as much as possible and also scale up remote access healthcare by using digital tools and Whatsapp video-calling to connect the provider and patients to decongest tertiary hospitals,” said Dr Mathur.

Creating safe areas with no overcrowding and other safeguards will help reduce patient hesitancy. “To prevent any spread of infection have these buildings, hospitals blocks completely segregated. My fear is that if we do not take steps, we will see many times over loss of lives due to non-covid reasons,” said Dr Chaturvedi.