World Cancer Day: ‘Delay in diagnosis during lockdown led to late-stage cancer’
The Covid-19 pandemic in March last year left hundreds of cancer patients – both within and those coming from outside the city – without early intervention and timely treatment. Due to the initial delay in diagnosis, hospitals in Mumbai have observed that almost 30% of patients are in advanced stages of the disease, thereby reducing their chances of recovery. However, 11 months down the line, with relaxations in lockdown restrictions, screening and diagnosis of patients has improved by more than 100%.
‘Delay in cancer treatment amidst lockdown’
On the eve of World Cancer Day, which is today, hospitals in the city said almost 30% of the newly diagnosed/registered cancer patients have developed advance-stage cancer due to delayed diagnoses during the lockdown, and many consequently have reduced chances of recovery.
In 2019, a total of 82,538 new cancer cases were recorded, which dropped to 60,699 in 2020.
In April, May and June 2019, the hospital recorded 6,933, 7,035 and 6,273 new cancer patient registrations. Following the outbreak of the pandemic, new registrations during the same three months in 2020 significantly dropped to 1,002, 3,020 and 2,688.
Citing several reasons for the drop of almost 20,000 new registrations last year, deputy director of TMH and gastrointestinal cancer surgeon Dr Shailesh V Shrikhande said, “Almost 60% of registered patients at our hospital come from outside Mumbai, including from neighbouring states. During the initial months of the lockdown, severe restrictions were imposed on transportation all across the nation. So, patients, especially those from outside Mumbai couldn’t come for diagnosis.”
At the beginning of the pandemic, several civic-run and private tertiary care hospitals were converted into dedicated Covid-19 hospitals. With outpatient departments (OPD) closed and non-emergency services temporarily halted, the number of cancer patients in private hospitals also reduced by almost 50%.
Dr Sanjay Dudhat, head of onco-surgery department, Nanavati Hospital, said that the pandemic resulted in a 45% drop in medical oncology (chemotherapy/radiation therapy) and a 69% dip in cancer surgeries as compared to 2019 at the hospital.
“Cancer patients are most vulnerable to getting infected with Covid-19 due to their weak immunity. As a result, many patients deferred visiting hospitals out of fear of constructing the virus,” said Dr Bharat Bhosale, medical oncologist at Bombay Hospital and Holy Spirit Hospital.
Dr Bhosale added that due to the economic slowdown, several working professionals lost their jobs, which changed the cancer care management system. “NGOs also had run out of funds, and couldn’t financially support the treatment of patients from the lower economic class,” he said.
‘Patients detected with advanced-stage cancer post lockdown due to delayed diagnosis’
With relaxations in restrictions, cancer patients who waited for months are now flocking to hospitals for treatment. Due to the late diagnosis, however, oncologists have found that recently-diagnosed patients have developed advanced-stage cancer.
“Almost one-third (or 30) have developed cancer at the third and fourth stage of the disease, which could have been cured if diagnosed earlier. Many have even died without getting treatment on time,” said Dr Sanjay Sharma, surgical oncologist and director of Asian Cancer Institute, Mumbai.
Doctors said that early detection is the most essential step in cancer management and eradication, and delay in diagnosis causes a rise in mortality rates.
“The key for a cure is to detect cancers in stage 1 or 2, i.e. within two to three months of cancer development in the body. As per our observations, the five-year survival rate in stage 1 and 2 of cancer is about 98%, which falls sharply to 30-40% in the advanced stages (3 and 4),” said Dr Dudhat. “On average, the tumour grows by 1cm within eight months to a year. Tumour biology in younger patients is more aggressive, causing faster development and spread in the absence of treatment.”
Doctors also said that patients detected with smaller tumours before the pandemic could have recovered through surgery. “However, as they delayed the treatment, we had to perform pre-surgical chemotherapy to reduce the size of the tumours, followed by surgically extracting them, and putting them on post-surgical chemo, radiation and hormonal therapy for complete recovery from the cancers,” said Dr Dudhat.
As patients couldn’t avail treatment at tertiary-care hospitals, they consulted local doctors who lack expertise, which further aggravated their health condition, said city oncologists. “In dire need, patients approached local hospitals with no adequate facilities. They performed ‘sub-optimal’ treatment which wasn’t up to the mark,” said Dr Sharma.
The pandemic also dried up blood banks as blood donation camps were halted to avoid any possible chance of spread of infection, which became a huge problem for patients suffering from blood-related cancer. “Bone marrow transplants need a large quantity of blood. Since these patients also have zero immunity against any virus, a few transplants were postponed during the initial stages of the pandemic,” said Bhosale.
‘Current situation is better, but coming months will be crucial’
Patient footfall has increased since September, said oncologists. For instance, registration of new cancer patients at TMH increased by 140% from August to December 2020. Similarly, at Nanavati Hospital, post the national unlock, there has been a 108% increase in the number of patients seeking cancer-related treatment and consultations.
“In November and December 2020, we recorded more registrations than in the same months in 2019. Also, there hasn’t been a huge fall in the number of emergency surgeries performed at our hospital. For instance, in my gastrointestinal oncology department, in 2020 we performed 250 emergency services, as opposed to 287 the previous year,” said Dr Shrikhande.
Doctors have cautioned that the coming months will be crucial to gauge the impact of delayed diagnosis on the fatality rate of cancer patients, as many in advanced stages are still undergoing treatment. “The drop in footfall indicates a probable increase in cancer fatalities caused by delayed or irregular cancer surgeries, radiation or chemotherapy,” said Dr Dudhat.