Status of cancer treatment amidst Covid19

By Dr M D Ray

Cancer is the second most common cause of death after heart disease worldwide. It is a hard fact that in India Cancer death is 1400-1500 per day. Every year 10-12 lakhs cases being registered. At a point of time 25 lakhs cases estimated in this country. Cancer namely oral, esophageal and lungs, Prostate, Stomach in the male and breast, cervix and ovary, Oral and Colorectal cancers in the female are most common in India.
Institutions like AIIMS are over burden always during Covid too.
Due to lack of data in past, we are also not in a proper shape to find out the ideal way to handle cancer patients. But on the basis of our own knowledge and experience and constantly generating data worldwide we frame out a protocol in our center. Still it is not fixed and varies as per the need of the patient and safety of health personnel as well as the patients
No doubt any emergency related to cancer like bowel obstruction, bleeding, inability to intake of food. Elective cases should undergo the appropriate treatment proper way. Now a days almost all the cancer center in India started doing cancer surgery with special precaution. No standard guideline is there. So the treatment is individualized.

Suggestion for cancer patients
Strict to one place of your choice as per your budget. Government hospitals are always better for those who are financially challenged. Those who have the option of chemotherapy, they can undergo chemotherapy first followed by surgery
Before admission COVID test is mandatory and another COVID test to be done within 24 hours before the surgery
It is considered safe to delay treatment for both surgery and radiotherapy 3 months for low risk and stable disease
High-risk patients need treatment at the earliest. Metronomic therapy (maintenance oral chemotherapy) also recommended during the preparation phase of the patient’s before the major surgery.
Important study regarding surgical outcome during COVID published in The Lancet, June 20
We know how COVID 19 affected Whole World! Medical services specially Surgical, more precisely rate of cancer surgeries slowed down throughout the Globe.

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study-
Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths.
So one thing to understand that performing cancer surgery is a daily routine for an Onco-surgeon but getting infected by COVID-19 may endanger life. As cancer patients are immunocompromised thereby chance of infection is much higher than the general population. Thereby precautionary measure is always mandatory before performing major surgeries.

Recommendation to prevent COVID infection and get the cancer treatment
Social distancing two meter. Using mask in a proper way (Snugly tight) specially in public space. Hand hygiene and sanitation. Lung Exercise, Intensive spirometry or Pranayama. Avoid to expose the rumor and opportunist. Do regular exercise, meditation and your own work and talk to your friends and love one. And from my side you can have Vitamin C 500 mg and Tab Zinc 50 mg once daily, both have cell protective and help to develop cell mediated immunity.
Vaccine is on the way to come but that is not 100% effective(Effective 60-90%).Storage ,Transportation and inoculation in a proper way is important issues in a highly populated country like India and one important thing to understand that immunity may persist only few months .
So my suggestion is – make the most whatever is in your hand i.e. Prevent Covid and get your cancer treatment at the earliest.

The writer is Dr M D Ray , Additional Professor, AIIMS , New Delhi.