Caregivers Caught between COVID-19 & Cancer

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By: Dr. V. Satya Suresh Attili, Head Medical affairs, EON

It’s a double jolt for cancer patients. While they are coming in terms with the fact that “they have cancer” and accepting- the COVID pandemic started gripping them to suffocate. 

The scientific dilemma and Oncology body recommendations

The initial approach of deprioritized, delayed, and discontinued oncology management is slowly getting better. Thanks to various global bodies, which worked relentlessly to come up with guidelines in a short possible time (with more logic and moderate evidence- whatever they can gather), the oncologists today are much better informed to make therapeutic decisions. The majority consensus is “Official advice is that urgent cancer care can continue, but other treatments should be rationed and adapted”

Social/logistic factors

The “lockdown” to have impacted the logistics of cancer medications and mobility of the patient’s to seek timely treatment. The redeployment of personnel, beds, and equipment to COVID-19 wards in few regions also contributed to the scarcity of the “quality Oncology care” on occasions.

The Oncologist Dilemma

As most of the recommendations as quoted in “The Lancet Oncology” are “inconsistent, and not evidence-based—multidisciplinary teams are being put in the unenviable position of making best guesses for each patient.” In my practice at least a few dozens “operable cases have become “inoperable” with inferior disease outcomes- It pains. With resource constraints “risk of delayed cancer treatment with disease progression” vs “Contracting COVID due to immunosuppression” is extremely challenging. There is no “best course of action” for an oncologist and these decisions are not easy to make

TESTING FOR COVID-19: What information is available on testing for COVID-19?

The corporates insist on ”test everyone” – and it’s more of a paranoid reaction- I believe which can potentially waste the limited testing resources and the ones in real need may suffer. While few of the governments say “test only if symptomatic” – which is more into “dismissive behavior” that leads to undertreating and faster viral spread. Having said that “it is difficult to draw a line” and balance. The only hope is to enhance the “testing capabilities”

Where does cancer screening stand

Well – I feel it’s a bit easier to answer. If the low risk of disease/ conventional screening- it’s best to wait. If it’s high-risk screening – well you may still wait based on the ”level of risk”. But for sure “there should not be any community camps” that can potentially spread the COVID like wildfire- and the lives you save by early detection are mathematically lesser compared to the risk of viral spread.

Are the rules Same

What are the recommendations for general care of patients with cancer?

ASCO encourages anyone caring for patients with cancer to follow the existing CDC guidance where possible:

General health care facility and health care professional guidance

Clinical care guidance

Home care guidance

High-risk subpopulation guidance- details can be found https://www.asco.org/asco-coronavirus-information/care-individuals-cancer-during-covid-19

IS the same rule true for surgery/chemotherapy/radiation/BMT etc

 Definitely not. There are matured and logical guidelines available from various reputed bodies and the detailed discussion on this is beyond the scope of this article- which can be browsed through various links ex- https://www.esmo.org/guidelines/cancer-patient-management-during-the-covid-19-pandemic

Where does technology help

Things like wearables for remote health monitoring, telemedicine, POC testing, AI-driven screening tools and what not – have surely helped the oncologists in this pandemic and paved the “way to future”

What about palliative care and home care

Probably these are the worst affected. Stress is more disturbing than cancer itself- They are already counting the days and trying to put their best to sustain the quality of life. But the logistics of medications and nursing care had impacted them as I see in my practice. The impact is worse in rural regions where two-thirds of my patients come from.

Cancer vs Covid deaths- extract from “The lancer Oncology”

A 5–10% decrease in survival in high-income countries has been predicted, which will account for hundreds of thousands of excess deaths, dwarfing those caused by COVID-19—but we are missing precise data on mortality that can be used to anticipate future cancer care needs

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