The Coronavirus pandemic and the subsequent lockdowns have impacted not only the cancer care but also the research in the field of it. The uncertainty has introduced new risks for cancer patients, disrupting the delivery of cancer treatment and the continuity of cancer research. Many elective surgeries were cancelled to redirect resources and healthcare staff to manage the coronavirus pandemic. But at the same time it has revolutionised the clinical care by the introduction of tele-medicine, artificial intelligence and digital healthcare services. It was the need of the hour to shift to the digital medium so that continuous healthcare services should be provided to the needy patients and curtail the spread of the virus so that patient can avail the services within the comfort of their houses.
For cancer patients, the challenging and unintended times began for those who didn’t know that they are going through cancer. Various studies have suggested that the pandemic led to a roughly 80 per cent drop in routine screening appointments that could catch new cancers in March and April. Since the cancer screening can’t happen virtually, the cases of breast, colon and cervical cancer also increased. Most of the screenings for above-mentioned cancer require an in-person procedure like a colonoscopy (for colon cancer), mammogram (for breast cancer) or a pap smear (for cervical cancer).
Delays in cancer screenings and treatment are expected to lead to more than 10,000 additional deaths from breast and colorectal cancer over the next decade. However as we are getting back to normal many healthcare centres are once again encouraging patients to come in for routine care. Many have implemented safety protocols that make it safe for most patients to come in for screening tests. Doctors are also asking outstation cancer patients, who are in the advanced stage, to get their chemotherapy done from their nearest hospital just in case travelling is an issue.
COVID-19 can be harsh on cancer patients: COVID-19 has a dangerous consequence of having an overaggressive immune response known as a cytokine storm, which can damage lung and other tissues. Patients with cancer are treated with immune-stimulating therapies such as immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapies and bi-specific T-cell engagers (BiTEs) are at the risk for complications if the immune response produced by these therapies results in an attack on normal, healthy tissue. Patients treated with CAR T-cell therapies and BiTEs, in particular, can develop a side effect known as cytokine release syndrome, which is similar to the cytokine storm in patients with COVID-19. Researchers have theorized that COVID-19 could aggravate cytokine release syndrome in patients treated with certain immunotherapies, but studies have not definitely shown that this is happening, a new report states.
To limit the spread of COVID-19, many laboratories have developed new policies so that limited number of lab workers can enter. This also resulted on putting many studies on hold. Many projects supported by private philanthropy group faced funding issues. Drastically decreased donations to cancer-focused philanthropic organisations have also been witnessed. This is not all. Some cancer centers also put a hold to all the enrollment on clinical trials entirely during the height of the pandemic. Despite these challenges, investigators have come up with variety of ways to adapt to challenging circumstances so that trials could continue. These included: leveraging telehealth, e-signatures for trial documentation and shipping oral medications and allowing tests to be done even outside the lab.
The Writer is Dr (Col) R Ranga Rao, Chairman — Paras Cancer Center at Paras Hospitals, Gurugram