Cancer care in lockdown
Actor Sanjay Dutt was recently diagnosed with lung cancer. Sapna Sarfare speaks to the medical fraternity and patients about dealing with the Big C in these testing times
The lockdown amidst COVID-19 pandemic has created utter chaos, especially for cancer patients. And getting treatment and dealing with related issues has become difficult. Recently, actor Sanjay Dutt was diagnosed with lung cancer. Despite plans to go abroad for treatment, the pandemic travel restrictions made him begin his initial treatment in Mumbai. For many other patients, help arrived courtesy special helplines and hospitals providing every help possible. Cipla Palliative Care & Training Centre in association with MCGM & PMC has created CAN-HELPER (Cancer Helpline for Emotional Respite) helpline for patients and their families to deal with COVIDrelated emotional challenges. They connect patients with qualified counsellors and volunteers from Tata Memorial Hospital and Cipla address problems. The Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC), New Delhi, also has a telemedicine patient app ‘RGCI Care’ for e-meetings, booking appointments, online consultation, get prescription and varied reports, etc. Handling cancer news by patients is another issue. Dr Manish Sharma, Consultant – Medical Oncology, RGCIRC, says, “Some have an emotional breakdown. Some face it with grit. Some remain in denial for a long time. There are others who start with much trepidation, but emerge stronger over time. Some old people accept it gracefully and believe it signals their exit from the world, but they continue with the treatment.”
Dr Rajesh Mistry, Director Oncology, Kokilaben Dhirubhai Ambani Hospital (KDAH), is pragmatic. “When the patients are explained the treatment, what to expect and the associated side effects, it becomes easier for patient to deal with the physical and emotional effects.”
The impact of the lockdown on treatment is enormous. Dr Mistry lists them right from fear of infection on a hospital visit to probable patients delaying consultation, diagnosis and treatment. “Most rely on family/friends to visit hospital – who themselves are not keen on coming to hospital.” Diagnosis and treatment means multiple hospital visits – another problem, he mentions.
Adding to this Dr Naresh Ramarajan, Founder & Chief Medical Officer of the Tata Memorial Centre (TMC) Online – Navya, says, “They are immunocompromised and are at five times the risk of a severe adverse ICU event. Between March-May, cancer patients were refrained from visiting the hospital unless absolutely essential. Major surgeries were delayed; infusion-based treatment deferred, diagnostic centres/cancer hospitals/ radiation centres were shut which created havoc. A recent news article said that cancer patients are now extremely threatened by the lack of healthcare resources amidst COVID-19. There’s also data that shows a 20% increase in cancer deaths than usual for this given year.” Navya Care is a collaboration between TMC and National Cancer Grid to give the best yet affordable online cancer consultation as per the patients’ needs anytime and any place.
Inability to connect with the hospital/doctors has caused patients immense stress. “Some who have survived the cancer and are under surveillance even they are not visiting the imaging centres for the fear of contracting Covid and that is likely to affect the outcome. In case of an unfortunate recurrence, the same is going to be detected late,” Dr Sharma states.
Navya’s work increased with worsening COVID situation, Dr Ramarajan reveals. “Since March, we’ve helped over 6,000 patients receive remote opinions. We initiated a free helpline service for all impacted by the pandemic. Reassuring a cancer patient to avoid/delay/defer treatment was so difficult but a necessary measure to curb early on. Reinforcing patients to visit local physicians was a bit challenging; given the trust they have on their treating oncologist.”
At present, Ramarajan thinks cancer care prominently includes family involvement. “They can be a source of strength and resilience or even a source of infection if not cautious. Reassurance, education, and encouraging patient and family to continue with the right treatment locally are all steps in the right direction through the Navya hotline.”
Dr Sharma feels hospitals and doctors are now even more responsible and follow the guidelines. “Thus patients are feeling emboldened to come to the hospitals. Simultaneously doctors are trying to minimise the visits without compromising on the treatment outcome.”
Medical guidance is vital in this period. Dr Mistry reveals many non-Mumbai patients cannot come to the hospital, and so are adviced to get online consultation or local chemotherapy/radiation/surgery treatment. “Patients must understand that treatment cannot be deferred indefinitely. With early cancer, delayed treatment will compromise with the final outcome. Patients with advanced cancer also cannot defer treatment as the quality of life will keep deteriorating. Hence the diagnosis and treatment has to go hand in hand with managing the pandemic.”
Dr Ramarajan rightly points ‘prevention is better than cure’. “Seek expertise online from renowned experts before your hospital visit and when absolutely necessary please visit your oncologist and commence treatment.”