For the past four to five months, most cancer hospitals have seen a significant reduction in patients. In several of the 220 centres attached to the National Cancer Grid, there has been a cumulative drop of 30 to 50 per cent in the number of new patients. Now, it is open to interpretation whether they have been going to smaller centres, or they have avoided hospitals because of the fear of contracting Covid-19.
Fortunately, the NCG was able to convince many state governments who were planning to convert cancer care centres into Covid-19 centres to permit them to continue treating cancer, given that the impact on the patients would be severe.
Cancer patients staying away from hospitals are likely to delay diagnosis, which is bound to result in patients presenting themselves in advanced stages. This is particularly true for certain kinds of cancer— for example blood cancers such as lymphoma and leukaemia—where days, and sometimes even hours, matter a lot. In such life-threatening situations, the delay can have a bigger impact than in other kinds of cancers. These are also the cancers which if treated promptly and appropriately, have better long-term survival outcomes.
It is true that cancer patients with their immunocompromised systems are at higher risk for contracting Covid-19. If the fatality rate is 3 to 4 per cent in the case of Covid-negative cancer patients, it is 8 to 10 per cent for those who have the disease. However, the chances of contracting the infection in the hospital are not high enough for them to reconsider whether to come to hospital for cancer treatment. Hence, I would advise those with suspected or proven cancers not to be apprehensive of approaching a hospital for cancer care. I would also suggest that they seek an expert with reasonable experience—by reasonable I do not mean only an oncologist, but someone who is an expert in surgery and medicine so that the urgency of the situation can be assessed and care can be sought. The risk of not getting appropriate and timely care is much higher than contracting Covid-19 disease, especially given that SARS-COV2 is going to stay here for a long time.
One of the things we have been promoting more aggressively is tele- and video-consultations for follow-ups and new patients. Since we are a tertiary care centre, we usually get patients who have already done at least a few preliminary tests. If they come to us with symptoms alone, we ask them to get the tests done at a centre closer to their home, and then seek a second-opinion through tele-consultation, if needed. In terms of Covid-19 precautions, cancer patients need no extra precaution other than physical distancing, maintaining hand hygiene, wearing masks and avoiding crowds.
As told to Namita Kohli
Dr C.S. Pramesh, director, Tata Memorial Hospital, Mumbai