The COVID-19 outbreak has posed a unique challenge for oncology experts across the country — to balance the higher risk of exposure to the virus on account of the treatments and the risk of progression of cancer in their patients. To tackle this, oncologists are switching patients to less aggressive therapies, postponing surgeries where possible and are opting to individualise the treatment approach for each cancer patient.
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Since February, when the SARS-CoV-2 virus had already found its way to India, Tata Memorial Hospital (TMH) in Mumbai began decreasing the intensity of chemotherapies in cases where it was possible. “Intensive cancer therapies result in decreased blood count, more immunosuppression and often requires blood platelet transfusions,” said medical oncologist Shripad Banavali of TMH. “These patients are thus at high risk of catching the infection,” he noted.
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Dr. Banavali, who is also the director of academics at the centre, said that they had relied on data from China, which showed a high mortality rate due to COVID-19 in cancer patients on active treatment. “We don’t know if it will affect the cancer outcome in the long run. But we have to look at what is more harmful in the present scenario,” he said.
An analysis of patients in China published in The Lancet Oncology in March stated that patients with cancer might have a higher risk of COVID-19 than individuals without cancer. “Patients with cancer had poorer outcomes from COVID-19, providing a timely reminder to physicians that more intensive attention should be paid to patients with cancer, in case of rapid deterioration,” the article’s authors wrote, further suggesting “intentional postponing of adjuvant chemotherapy or elective surgery for stable cancers in endemic areas”.
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“Data from China has shown that mortality in cancer patients was two times higher as compared to general patients with COVID-19,” observed Ashok Vaid, chairman, medical and haemato oncology, Medanta Hospital, Gurgaon. “Italy had recorded a 20% mortality in cancer patients. We have to use this data for our learning. We are trying to make multiple interventions on case to case basis. For example, we are switching elderly cancer patients on oral therapies instead of intravenous, opting for milder therapies and also reducing their hospital visits. But it all differs on a case to case basis, based on the biology of cancer,” he said.
Mumbai-based surgical oncologist Vinay Deshmane said his team had been postponing surgeries if possible and were operating only on cases where surgery couldn’t wait. “I am also advising three weekly therapies instead of weekly therapies. The idea is to not have a rigid outlook and treat each case individualistically,” he said.
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The lockdown has already resulted in reduced patient footfall. “We are not discontinuing the ongoing regimens,” said Amal Kataki, director of Dr. B Borooah Cancer Institute, Guwahati. “But we are modifying the treatment protocol in some cases so that the risk of COVID-19 is mitigated as much as possible,” Dr. Kataki added.
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