Caring for cancer patients amid Covid-19 crisis
In the current scenario, caring for cancer patients is the biggest challenge for oncologists. Cancer patients usually have compromised immunity levels to fight various infections due to the disease itself and also its treatment, which involves doses of steroids, immune modulators, chemotherapy agents and radiation therapy.
Care of cancer patients, in the new normal of today, faces a dual challenge. One, compromised immunity makes them more susceptible to Covid-19. In addition, the severity of the infection, if contracted, may also increase. Two, Covid-19 may cause severe complications in patients on active cancer treatment, which may need isolation, intensive care and mechanical ventilation.
Guiding principles are the same for the general population, cancer patients and their caregivers. Staying home, safe distancing, frequent and regular hand washing with soap and water for at least 20 seconds, use of hand sanitisers with 60% or more alcohol, masks to be worn anywhere and everywhere, and especially during a visit to the hospital, as they have to be very cautious. Some clinical visits may be deferred where active treatment is not indicated; telephonic consultation or video conferencing has been recommended by some for this period. Patients with fever and recent cough should be sent for screening triage and screened for Covid-9 wherever indicated.
The main challenge is how to continue cancer treatment. There are no specific guidelines for this, but recommendations are given by renowned global agencies such as NCCN, ASCO, ESMO. Cancellation of all elective procedures can be considered where a delay of six to eight weeks will not lead to a detrimental effect on the health of the patient, whereas time-sensitive procedures may be rescheduled by a few weeks. Standard of cancer care with chemotherapy and radiation therapy during pandemic may vary from patient to patient. Delay or skipping treatment, change of infusion-based treatment to oral treatment can be considered in best interest of a patient’s health. However, a mutual consensus between the treating oncologist and the patient is vital before taking any decision.
Dr Vineet Talwar, DM, FRCP (UK) FICP, FIMSA, MNAMS and director, Dept of Medical Oncology, Rajiv Gandhi Cancer Institute.