Dr Vishal Kulkarni, Consultant Medical Oncologist and Hematologist, HCG NMR Cancer Centre Hublli elucidates how COVID-19 has impacted the delivery of oncology services in India
The COVID-19 pandemic has led to a remarkable loss of human life and has presented an unprecedented challenge to public health. It has disrupted the functioning of all sectors, including healthcare systems, which has resulted in the interruption of usual care and exposure of vulnerable patients.
The disease has substantially affected cancer care across the globe and has had significant impact on the delivery of oncology services in India. The care of non-communicable diseases like cancer is dependent on the stage of diagnosis, and, hence, any disruption which leads to delays in diagnosis will impact treatment and survival. As per the Lancet Oncology study, India reports about 1.3 million cancer cases annually and almost eight per cent of total deaths. This is likely to increase in the next five-to-10 years due to delay in diagnosis and treatment owing to the pandemic.
As of June 2021, India has been recovering from the second wave of this deadly pandemic. During this wave, the response has been more nuanced with more flexibility and decision making at the district level. Nevertheless, this pandemic has strained the healthcare systems to the brink, and has resulted in an increase in morbidity among patients with non-communicable diseases like cancer.
The reasons for this can be many, but five major reasons for this increase in mortality and morbidity could be: overwhelming of COVID-19 affected patients in hospitals which rightly resulted in a greater allocation of healthcare resources, thereby blunting cancer care; logistical challenges due to lockdowns and other restrictions resulting in reduced access to healthcare for patients; financial insecurity and loss of wages among the informal sectors of the economy resulting in hesitancy among patients to seek timely care; fear of contracting COVID-19 while visiting hospitals and healthcare facilities among the general public, especially in the early stages of the pandemic; and confusion about treatment guidelines, especially early in the pandemic, resulting in postponement and deferral of several critical treatment modalities.
Across the cancer centres, major reductions were seen in new registrations, out-patient services, major surgeries and the number of imaging services utilised. Radiotherapy and palliative services did not see major reductions. These reductions corresponded mainly to the months between March 2020 to May 2020 and April 2021 to May 2021 when the lockdowns were more intense. However, these tended to normalise once the restrictions were eased. One important adverse impact has also been on the drastic reduction in the education and training sessions for all oncology.
Due to ongoing pandemic screening programmes and camps for early detection of cancers such as cervix, breast and oral cancers have become rare. These cancers account for more than 50 per cent of the total cancer burden in India. This might lead to delayed diagnosis and advanced stage at presentation of these cancers in the near future. Cancer research has also been adversely impacted due to the lack of research grants to the unwillingness of patients to travel to hospitals to be part of a clinical trial.
Among the positives resulting from this pandemic are the increase in teleconsultation and video-consultation facilities. Further, the wiser allocation of healthcare staff which has resulted in overall reduced exposure and thus mortality. Due to the pandemic, there has also been a general shift in patient preferences to take treatment more locally in tier-II and -III cities thereby reducing the healthcare burden on the tier-I cities.
Major lessons have also been learnt by the government establishments and cancer care providers in this pandemic. Optimising cancer care, while taking necessary precautions to prevent contraction of COVID-19 by the patients, has been largely successful. Priority has been given to strengthen the public healthcare systems. In addition, importance of value-based care both in terms of benefit and cost is being given major impetus.
Hopefully, we, as a society, will be better equipped to face healthcare challenges like the current pandemic without compromising the treatment of diseases like cancer in the coming decades. The burden on healthcare and impact on society will be far greater in the ensuing decade if the care of chronic and non-communicable diseases like cancer is compromised during global health crises like the current pandemic.