Thursday, June 25, 2020

Caregivers Caught between COVID & Cancer

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

The scientific dilemma and Oncology body recommendations
The initial approach of deprioritised, delayed, and discontinued oncology management is slowly getting better. Thanks to various global bodies, which worked relentlessly to come up with guidelines in short possible time (with more logic and moderate evidence- whatever they can gather), the oncologists today are in much better informed to take 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” too 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 few dozens of “operable cases have become “inoperable” with inferior disease outcome- 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 any 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 its 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 behaviour” that leads to undertesting 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 its bit easier to answer. If low risk of disease/ conventional screening- its best to wait. If its 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

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 trhough 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 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 from 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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