Care for cancer during COVID-19 pandemic

Sir,

The article by Sahoo et al1 is appropriate in the context of sustaining routine healthcare during the pandemic. While the study was limited to 49 cancer patients only, with other non-communicable diseases (NCDs), the overwhelming fact was still evident - the pandemic deteriorated the care received by cancer patients. To re-emphasize, cancer is responsible for 8.3 per cent of deaths in India2. During the pandemic, on the one hand, there was a fear of contracting COVID-19 and higher vulnerability due to immunosuppressive state, and there were lockdown and other restrictions on the other hand3. Limited availability of telemedicine restricted the care-seeking behaviour of chronic patients, particularly cancer. Unlike diabetes and hypertension, where home-based monitoring was a feasible option, cancer patients needed to depend on tertiary care hospitals for their care. If we add financial uncertainties imposed by social restrictions, the balance probably got tilted towards out-of-pocket expenditure. Shifting a major portion of working doctors towards COVID-19 would, for obvious reasons, reduce the number of doctors looking after cancer and chemotherapy. The unwanted delay in care possibly resulted in chemotherapy received irregularly, postponement in the initiation of therapy and resultant advancement of cancer from a curable stage to an incurable one, in some cases which might potentially change a curative approach to a palliative one3-6.

To summarize, there is a need for an in-depth study, preferably pan-national, to understand the magnitude of the problems faced by cancer patients during this pandemic. It would help us in identifying the areas where we could improvise and provide better care if similar situation arises in the future.