The mortality rate of Covid-19 infection is reportedly high among cancer patients. A study, published in The Lancet, involving about 900 cancer patients with Covid 19 infection, found the mortality rate to be 13%. The patients were from the United States, Canada, and Spain. A similar study of about 800 cancer patients with COVID-19 infection from the UK reported that nearly 28% of them died. These cancer patients were from the UK.
India’s cancer burden is huge. According to WHO, India had an estimated 1.16 million new cancer cases in 2018 – and 2.26 million 5-year prevalent cases. The country is also heading to be the Covid 19 capital of the world with the projections of several crores of Covid cases within a few months – despite hard lockdown, continued social distancing and isolation of cases.
In this context, it is highly likely that a significant number of cancer patients are likely to have Covid infection. Hence, decisions must be taken as to where the focus of the medical interventions should go: Covid or cancer or both. And the decisions should be based on risk/benefit analysis done for each patient. Sometimes, cancer treatments have to be withheld and some other times, they have to be continued.
Covid First
If you are a cancer patient, and if you develop symptoms of COVID-19, generally the priority is to isolate you and treat your infection – rather than your cancer – first. The cancer treatment can be resumed once you have recovered sufficiently from COVID-19. It is important to understand that in many cases it is perfectly safe to delay treatment slightly. If you are not on active cancer treatment, you should not visit doctors for routine follow-ups.
Unless it is an emergency, hospital visits for palliative therapy can be postponed. Don’t visit your hospital for routine lab samples – you could get the samples collected from home. It is recommended that chemotherapy treatment can be stopped altogether for the infected patients when cancer is in deep remission and if the patients receive chemotherapy only as maintenance therapy. Similarly, all major elective cancer surgeries and procedures can be delayed.
Cancer First
In some cases, delays or modifications of treatments may pose a higher risk of compromised disease control. It may affect the survival of patients. In such contexts, withholding critical anti-cancer treatments is not recommended.
Cancer Hospital must be delivered to all serious or emergency cancer cases – including oncological emergencies for radiation, as done routinely. Curative treatment should be continued as planned to ensure the best chance of remission. Modifying anti-cancer treatments – like switching chemotherapy from IV to oral therapies – is another option, if it could decrease the frequency of your clinic visits.
Self Care, always
Focus on what is in your hand. If you are a patient, it is very important that you continue to lead a healthy lifestyle during the pandemic.This will enable you to cope better during cancer treatment and the follow-up period. It is crucial that you have a healthy diet – make sure you can access the food that you need. Have more fresh fruit and vegetables.
It is very important to look after your mental health too during these challenging times. Stay in regular contact with friends and family via phone, email, social media and video calls. You should also contact your doctor or nurse if you feel you need additional emotional support from a psychotherapist or counsellor.
Withholding anticancer treatment or not depends entirely on a set of individualized factors that include age, stage of cancer, your immune health, and so on. Modify your lifestyle in favor of good food, good exercise, and good social interactions – and trust that your doctor will suggest treatment modalities only if they will be in your best interests.