Impact of Covid on cancer care: Unaddressed problem and the possible solutions
The piece has been authored by Dr Parth Sharma a registrar of the department of medical oncology, Christian Medical College, Vellore. And Dr Ashish Singh is associate professor and the head of the department of medical oncology, CMC Vellore.
The Covid-19 pandemic has had a catastrophic impact on cancer care. As of December 2021, Covid-19 infection has affected more than 250 million people causing nearly 5.5 million deaths worldwide. The direct impact of Covid has been widely studied, but attention needs to be drawn on the indirect impact of Covid on other illnesses like cancer. Cancer cases increased by nearly 324% from 2017 to 2018 in India according to National Health Profile, 2019 data. However, a rise of only 29% in cancer cases was noticed from 2020 to 2021. This highlights a huge number of missed cases which will increase the burden on the health care system in the coming years.
A study done in England showed a substantial increase in avoidable cancer-related deaths as a result of the impact of an ongoing pandemic on cancer care. The total additional years of life lost (YLL) across oral, breast, and colon cancer were estimated to be 59,204–63,229 years. Between March 1 and May 31, 2020, there was a 54% reduction in the number of new cancer patients registered, and nearly half the patients were lost to follow-up in India according to a Lancet oncology study. Treatment was affected in terms of reduction in hospital admissions, decreased outpatient chemotherapy, decrease in major and minor cancer surgeries and decrease in radiotherapy administration. Cancer screening was either stopped completely or was running at less than 25% of the usual capacity at more than 70% of hospitals in India during these months. A multinational study done across 54 countries showed that although 55.34% of centres reduced services as part of a pre-emptive strategy, other common reasons included an overwhelmed system, lack of personal protective equipment, staff shortage, and restricted access to medications. This has led to a delay in diagnosis which has caused curable cancers to present in an advanced stage where only palliative treatment can be offered.
Increased incidence of advanced-stage disease and increased cancer-related mortality have been noticed in CMC Vellore, a leading cancer care centre in South India. The economic impact of Covid has made cancer care unaffordable for a majority of the population. Shortage of drugs and unknown effect of Covid on cancer patients has led to change in treatment protocols thus reducing the effectiveness of treatment. “After spending all his money on institutional quarantine after turning Covid positive during the first wave, a patient who had come to CMC from West Bengal for cancer treatment had to return home as he could not afford further stay in Vellore,” according to an oncologist from CMC Vellore. Abrupt withdrawal of funding and interruption of cancer-related research also affected thousands of patients worldwide who were dependent on clinical trials for their treatment.
Unlike the Covid-19 pandemic, the pandemic of non-communicable diseases like cancer is not so dramatically evident. The seemingly endless pandemic has already exposed our inefficient health care system. We need to now prepare ourselves to deal with the burden of chronic diseases. The health care system needs to evolve, and more focus needs to be laid on the primary health care system in our country. While capacity-building at the tertiary healthcare level is important, we need to also strengthen our community outreach programs and our primary health care centres.
‘Knowledge conquers cancer,’ has been widely embraced as the new tagline in the fight against cancer. Spreading awareness about common cancers and the associated risk factors is the need of the hour. Starting from school till the institutional level, masses need to be educated regarding risk factors and early signs of cancer. Studies from India and abroad have shown that community-based cancer screening leads to a significant reduction in cancer-related deaths. Cancer screening hubs need to be established at the community level to screen for common cancers. The national programme for prevention and control of cancer, diabetes, cardiovascular disease, and stroke (NPCDCS, established in 2010) under the National Health Mission provides free screening for diabetes, hypertension, and common cancers in government hospitals. More screening camps need to be organised by the government under this national policy.
Capacity-building at the secondary and tertiary health care level needs to be focused upon to manage the existing backlog. Training in cancer diagnosis and treatment needs to be strengthened in our country. The total number of DM oncology seats at present is only 139 which is not enough for a country with nearly two million people being diagnosed with cancer every year. Lastly, government-funded cancer research to invent better cost-effective treatment regimens could help in tackling the overwhelming burden of this unaddressed epidemic of cancer.
India is one of the youngest populations in the world, its available workforce can be a solution to this growing problem. Addressing this emerging predicament will not only transform the health care industry but also present several opportunities for growth in the government sector, both in terms of revenue and employment. Covid-19, the biggest health emergency of our times has not only exposed the myriad of challenges and gaps in our health care system but also highlighted the importance of investing in the prevention and treatment of chronic diseases like cancer.
Dr Parth Sharma is a Registrar of the Department of Medical Oncology, CMC Vellore and Researcher at the Lancet Citizen’s Commission on Reimagining India’s Health System and Dr. Ashish Singh is an Associate Professor and the Head of the Department of Medical Oncology, CMC Vellore. Views are personahe l.
( The piece has been authored by Dr Parth Sharma is registrar of the department of medical oncology, Christian Medical College, Vellore and researcher at the Lancet Citizen’s Commission on Reimagining India’s Health System and Dr Ashish Singh is associate professor and the head of the department of medical oncology, CMC Vellore. The views expressed are personal.)