Covid-19 death rate among Mumbai’s cancer patients stands at 9.8%: Tata Memorial Hospital

Even though the death rate for Covid-19 in Mumbai is 3.9%, the fatality rate among cancer patients co-infected with the Sars-CoV-2 virus is as high as 9.8% owing

Even though the death rate for Covid-19 in Mumbai is 3.9%, the fatality rate among cancer patients co-infected with the Sars-CoV-2 virus is as high as 9.8% owing to their compromised immunity, according to data shared by Tata Memorial Hospital (TMH), Parel.

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In Mumbai, since the outbreak of the pandemic, a total of 257,497 cancer patients contracted Covid-19, of which 10,293 succumbed to the infection. TMH, the leading cancer hospital in India which receives 70,000 cancer patients every year, has treated 1,140 cancer patients with Covid-19 co-infection between March and October, of which 112 died of the infection.

Due to their treatment, cancer patients become immunologically weak, which increases their chances of contracting the viral disease, said oncologists. “Among immunocompromised patients, the body’s white blood cells, which fight infections, become low or don’t function. This fails the body to fight the infections effectively. This makes cancer patients, especially those who are on active chemotherapy, most vulnerable to the infection,” said Dr CS Pramesh, director, TMH. “The infection and mortality rate are the highest among cancer patients above the age of 50. If they have other co-morbidities, their infection becomes deadlier,” he added.

Patients who are undergoing active treatment for cancer are presumably at higher risk than those who are in remission. “Active cancer patients have to be extra cautious due to their low immunity. Since March, we have treated 141 Covid-19 positive patients with cancer. Of them, five have succumbed to the infection,” said Akash Aanand, assistant medical superintendent of Homi Bhabha Cancer Hospital, unit of TMH, Varanasi.

A study, ‘COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort’, published by the Lancet shows that the mortality rate is 30.6%. The researchers conducted the study on 1,044 cancer patients with co-infection at the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8. Of them, 316 patients died.

Oncologists said fatality rate in India is lower than developed countries as the consumption of smokeless tobacco is limited. “In India, the consumption of gutkha is more than western countries where cigarettes are more common. In comparison to the US, UK, where the death rate ranges from 15-30%, we can save co-infected patients more,” said Dr Pankaj Chaturvedi, deputy director, centre for cancer epidemiology at TMH. Dr Chaturvedi has also been overseeing the treatment of Covid-19 cancer patients at the NSCI jumbo centre and has so far treated over 500 co-infected patients.

As per city oncologists, patients with haematological malignancies, when cancer affects the blood, bone marrow, and lymph nodes, are more vulnerable. “Patients with haematological malignancies are at highest risk. Their cancers directly affect their immune system. Thus, they fail to fight with the virus. Also, it has been observed that during therapies that it can cause severe myelosuppression (bone marrow suppression which reduces the production of blood cells) and lymphodepletion (destruction of lymphocytes and T cells),” said Dr S Chandrakala, haematologist, King Edward Memorial, Parel.

“Studies have shown that patients with solid organ tumours have lower death rates,” she added.

During the initial days of the lockdown, cancer services were largely disrupted which affected clinical research, diagnosis and delivery of treatment.

In the first three months between March and May, the overall footfall of cancer patients decreased by almost 50%, according to oncologists. For instance, during April and May, TMH saw only 45% patients (60-70). The numbers are rising again and between August and September, the hospital got 150 new patients daily. Of these, 10-12 have co-infected patients. Before Covid-19, TMH would get over 200 patients a day.

Lockdown travails

Dr Neha Choudhary, 23-year-old, a medical student at Jaipur developed a large cancer tumour mass in her chest around her heart and lungs. It was making her breathless. She needed surgery immediately as chemotherapies also didn’t prove effective. But due to the lockdown, she couldn’t travel to Mumbai to get operated upon and had to wait for three months until June. Dr Anil Sanganeria, a surgical oncologist at Saifee Hospital, who operated upon her, said, “It was a common story of all cancer patients during lockdown. If it had not been removed, it would have caused her a life-threatening suffocation.”