Impact of COVID-19 on cancer care

World Cancer Day 2022: Cancer patients are more likely to be infected with COVID-19

The COVID-19 pandemic has claimed 5.6 million lives worldwide. It has strained health systems and drastically reduced the ability to treat non-COVID-related illnesses.

Cancer is a complex disease and the results of treatment depend on the time of diagnosis and the time of treatment provided. Many oncology centers have restructured their departments to create COVID-19 units. There have been reductions in the number of doctors and nurses due to infection, quarantine or a deliberate staff sparing strategy. Access to health facilities has been restricted due to travel restrictions, COVID infection of patients or their family members and reluctance of patients to visit hospitals for fear of exposure to COVID infection. This has led to possible delays in cancer diagnosis and management, which are known to affect treatment outcomes.

Cancer patients are more susceptible to COVID-19 infection. According to a recent publication, the viral load of SARS-CoV-2 has been found to be an independent predictor of hospital mortality in cancer patients. Cancer patients have weakened immune systems and are often comorbid with type 2 diabetes or cardiovascular disease, leading to poor overall health and increasing their susceptibility to COVID infection. It is therefore more difficult to predict disease progression and manage disease symptoms in cancer patients. Additionally, most chemotherapy drugs are cytotoxic, which suppresses the immune system and predisposes the body to an immunosuppressive status, making cancer patients more susceptible to COVID-19 infection and developing severe disease.

According to a multi-institutional study of 41 oncology centers published by National Grid of India, it was identified that there was a 54% decrease in the number of new patients registered, a 46% decrease in follow-up visits, a 36% reduction in hospital admissions, 37% reduction in outpatient chemotherapy, 49% reduction in major surgeries, 52% reduction in minor surgeries, 23% reduction in radiation therapy and 43% reduction in X-ray diagnostic testing during peak COVID times. Cancer screening was completely halted or operating at less than 25% of its usual capacity in more than 70% of centers during these months.

All aspects of care, including screening, diagnosis, treatment, palliative care and follow-up, have been reduced during the pandemic. This will result in delayed diagnosis and suboptimal treatment for a proportion of patients who would have been diagnosed with cancer during this time. According to the study, this delay in the diagnosis and treatment of cancer may become a serious public health problem in the coming years.

Oncology centers and societies should develop separate guidelines for the treatment of cancer patients in COVID-affected regions and delays in diagnosis and treatment should be avoided. Physicians treating cancer patients should follow evidence-based treatment guidelines to optimize cancer management while simultaneously balancing the risks of SARS-CoV-2 infection and measures such as teleconsultations, consultations video and the separation of non-COVID and COVID hallways in the hospital could help reduce treatment delays for these patients.

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(Dr Pradeep Jain, Director, GI & HPB Onco Surgery, Fortis Cancer Institute, Shalimar Bagh, Delhi)

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