Oncologists across the world have expressed concern over the probability of rising cancer mortality and morbidity, not because of the coronavirus pandemic per se, but because of the inability of the healthcare system to treat cancers as it normally should, writes Dr (Col) R Ranga Rao for South Asia Monitor
A 40-year-old woman was diagnosed with aggressive but curable breast cancer at Paras Hospital in Gurugram in February this year, and was advised immediate treatment. The family returned to their hometown 200 km away to make arrangements but could not return for treatment as the COVID-19 outbreak sparked fears and logistics concerns as well as a prolonged nationwide lockdown. When she was finally brought back after three months, she was in a sick and moribund condition, obviously due to the spread of cancer. Unfortunately, nothing much could be done.
The woman is not a one-off case of COVID-19 impacting patients with other serious diseases. Every oncologist would be able to narrate several such heart-breaking stories. In a worrisome trend, cancer patients seeking medical treatment have dropped to less than 50 percent in India in recent months. The same thing has happened to other non-COVID specialities, both communicable and non-communicable.
Unfortunately, none of the corona scoreboards ever talk about the hidden damage or collateral of the COVID era, other than economics. Apart from the huge economic consequences that have impacted millions of people, coronavirus has also led to unintentional fallouts in non-COVID areas of healthcare. Fear of contracting the disease in health care settings, lack of local logistics, unknown fears, newer myths, economics etc. have dissuaded people from visiting hospitals for diagnosis, treatment for non–COVID-19 diseases. This entails a major threat for people with chronic diseases who need constant monitoring and treatment - patients with diabetes, hypertension, kidney disease, and cancer to name a few.
Also, the population of South-Central Asia and SAARC (South Asian Association for Regional Cooperation) countries form 26.68 percent and 24.59 percent of the world population, respectively. As far as cancer in these regions is concerned, the incidence of new cases is 11.24 percent and 10.23 percent of the world’s cases. Yet, the burden of cancer deaths as compared to the incidence is 68.85 percent and 68.44 percent, respectively. This compares poorly to 59.74 percent for the world. This well-known fact reaffirms that these regions of the world need to improve their cancer management strategies.
COVID-19 hampers cancer care
In the initial period of the pandemic, most non-COVID specialities functioned at a minimal occupancy rate. Most cancer facilities stayed underutilized as people refrained from visiting due to the threat of infection. In some cases, lack of logistics support contributed to this underutilization. Make no mistake; in treatment of cancer, time is life. Cancer care can neither be delayed nor be compromised. For new patients and those on treatment full-fledged treatment is required without any delay including surgery, radiotherapy, chemotherapy, regular tests etc. Delayed diagnosis can itself be a death sentence for many.
Similarly, emergencies are common in cancer patients and need to be well attended. In a country where a majority of cancer cases are already diagnosed in the later stages, prolonged lockdown and inability of people to visit hospitals is sure to have caused many preventable deaths. For thousands of people from India’s less developed states who travel to nearest metropolitan cities for treatment, COVID-19 has been a disaster.
Oncologists across the world have expressed concern over the probability of rising cancer mortality and morbidity, not because of the coronavirus pandemic per se, but because of the inability of the healthcare system to treat cancers as it normally should. A 5–1 percent decrease in survival has been predicted in high-income countries for cancer patients. This number would dwarf COVID-19 deaths easily. In the US, about 25 percent cancer patients were reported to have been experiencing a delay in treatment. India too is likely to witness a rise in mortality in cancer patients.
Having a close look at the numbers of cancer patients in India will give us an idea about the potential impact of this disruption in care. Each year 1.7 to 1.8 million new patients, along with 3 million pre-existing patients requiring cancer care! COVID-19 has not only disrupted treatment for thousands of existing patients but also delayed diagnosis of thousands of others. While there is no way to find out the exact number of affected, it is certain that this cancer care disruption will lead to several thousand preventable deaths.
Lack of care for other chronic diseases
The number of non-COVID patients with both communicable and non-communicable diseases whose treatment may have suffered to some extent due to COVID-19 would be staggering. There are 30 million of end-stage renal failure patients in India with 0.7 million added each year, 1.8 million of stroke patients, over 25 million patients with heart ailments and 2.4 million patients of tuberculosis. Besides, millions of routine infections and diarrhoea in children happen every year. Considering the most optimistic estimate of 50 percent of them getting proper attention, the loss of lives, human suffering due to lack of, delayed or improper treatment will surpass the COVID numbers by a long margin.
Concerted measures required
A number of concerted measures taken at the government level, public level, media level as well as at the level of healthcare providers can help in minimizing this unfathomable tragedy.
- * Streamline safe non-COVID centres to resume and continue their services. Mechanisms must be established to ensure the least encroachment of specialised centers for COVID care and protection from COVID infections. All the patients and attendants visiting the facility must be regularly checked and screened for coronavirus and any infections. All protocols and standard operating procedures (SOPs) for infection control must be in place and implemented so that the confidence of the patients builds up in the facility. Staggering of patients visiting by appointment is another desirable intervention.
- * The government must put the impetus on the continuation of treatment through measures such as safe travel for non-COVID patients and awareness campaigns about the need to continue unhindered medical care. Hospitals should endeavour to restore the confidence of patients and people about the risk of COVID infections. Creating good COVID free channels and generating awareness through mass media will help restore confidence.
- * This is not to abandon COVID patients in the least. Creation of ad hoc facilities and ad hoc ICUs using public buildings, religious places, hotels stadiums etc. is essential to ensure that all COVID patients get required care even as specialised centres and hospitals continue to deliver essential care to millions of other non-COVID patients.
(The writer is Chairman, Paras Cancer Centre, Paras Hospitals, Gurugram, India. The views expressed are personal)