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Managing breast cancer treatment during a pandemic

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As October is Breast Cancer Awareness Month, Dr Mandeep Singh Malhotra, Surgical Oncologist, Head, Neck and Breast Oncology, Fortis Flt. Lt. RajanDhall Hospital, Vasant Kunj presents a few suggestions and learnings on the precautions to be taken and for evolving an optimum treatment plan to ensure that patients can easily navigate through their consultation and treatment during the current COVID-19 pandemic

When 60 year old Sujata (name changed) was diagnosed with cancer a few months ago, it left her family with a number of questions about her treatment, access to hospitals and the uncertain future. Facing a breast cancer diagnosis is a huge challenge in itself. Being diagnosed during a global crisis such as a pandemic is a bigger and additional challenge that adds to the complexities of managing the disease. From figuring out the right treatment to protecting oneself from exposure to risk, there are a number of steps and precautions that cancer patients and their families must take.

A number of reports have suggested that cancer patients are at a higher risk of contracting COVID19 infection that may result in fatality. This increased risk is mainly due to factors like comorbidities, underlying cancerous growth and treatment related immunosuppression. A report by Asian Pacific Journal of Cancer Prevention indicates that cancer patients are more likely to contract coronavirus infection than individuals without cancer. This is mainly due to their immunosuppressive state because of the malignancy and anticancer treatment.

One of the major impacts of the pandemic on cancer care has been the delays in oncology treatment. A number of patients avoid going for treatments to avoid risk of exposure. Unfortunately, cancer is one among those diseases where any kind of treatment cannot be delayed or neglected. Time is of utmost importance.  On one hand, a patient might be at high risk of contracting COVID-19 infection and dying from it; on the other hand, the patient might be at high risk of the cancer progressing or causing death if it is not treated appropriately. How do we create an optimum treatment plan to ensure that patients can easily navigate through their consultation and treatment during a pandemic?

After we went through multiple lockdowns in, we came up with a better understanding about challenges and possibilities and about the new world that we will be living in for now. The diagnosis and treatment of cancer had to also evolve to keep pace with the current challenges. Here are a few suggestions and learnings:

Tele consultation and hospital visits: If a pandemic of this magnitude had hit us a decade ago, there wouldn’t have been an option of teleconsultation. Doctors have started using teleconsultation in a big way. In many cases, it helped continuity of care and allowed routine follow-up to be done without increasing a patient’s exposure to coronavirus. Patients must not discontinue or avoid going for consultation for the fear of contracting the virus. They can use teleconsultation for the initial consult where the relevant imaging and work up can be advised and patient can come for physical consult with all the relevant reports definitive procedures like biopsy, etc. This saves patients from multiple hospital vists. At the hospital, there are enough protocols and processes in place to avoid the risk of infection.

Check for modified treatment protocols and processes: Early diagnosis is the solution for controlling the cancer and it also helps in getting cancer treatment during the present COVID times. If a patient is diagnosed in early stages of breast cancer, as per ESMO (European Society for Medical Oncologists) and other guidelines patients who are hormone receptor positive can entirely avoid chemotherapy if they are low-risk as per a prognostic test i.e. If the  women presents with cancer with smaller lumps and limited nodal disease, which after a Breast Preserving Treatment turns out to be an early stage hormone positive disease, which 50 per cent times it will be; can be just put on hormone therapy tablets after risk assessment analysis (RA). Thus, patients who we are able to manage only with hormonal therapy are saved from multiple hospital visits and their immunity is prevented from going down, thus decreasing COVID-19 transmission dramatically.

In India, patients can opt for ‘CanAssist Breast’ test that will clearly tell the patient if they fall under high risk or low risk category. This is an indigenously developed RA which is being done at affordable costs vs those being done in the west. On the basis of the risk score, oncologists can decide whether the patient requires chemotherapy. If a patient can avoid chemotherapy then this really reduces their risk of COVID-19 related complications because their immune system is not compromised. Even if chemotherapy is prescribed for high risk patients, it is possible to change the dosing schedule or convert to oral chemotherapy.

Mental health of the patient: With everything that’s happening around us, it’s natural for cancer patients to get overwhelmed with the diagnosis, treatment, consultation and other processes. In situations like these, family members and doctors can play a significant role in helping the patient take the right decisions and navigate treatment. Eating the right food, exercising as per recommendations, talking to loved ones can help overcome feelings of anxiety. If a patient is undergoing intense feelings of stress and anxiety, it’s best to seek help from mental health experts.

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