The question isn’t necessarily whether cancer treatment can or should be delayed on its own, but whether the risk of COVID-19 outweighs the risk of suspending cancer treatment. As infections, small or big breakouts, epidemics and rare pandemics might become routine given the rapid rate of urbanisation and globalisation, Dr (Col) R Ranga Rao, DM Chairman, Paras Cancer Centres, Paras Hospitals, Gurgaon recommends that there is a need for structural reforms for existing and future hospitals so that they create functional SOPs and infrastructure in order to tackle future outbreaks.
Hospitals and health care providers across the country continue to mobilise their resources to respond to and contain the COVID-19 outbreak. A huge human and economic toll can already be attributed to this pandemic. Not only is there suffering directly caused by the outbreak of this coronavirus, the impact on patients with other diseases has also been significant. Some cancer patients have already had to adjust to or work around delays in their care. Others worry that their upcoming procedures will be cancelled or postponed.
Cancer patients tend to be immunosuppressed due to the disease and also due to treatments like chemotherapy. Hence there is a risk in initiating treatment which might predispose patients to COVID-19. However, a delay in their treatment could cause a cancer flare-up, and may cause a curable cancer to progress to an incurable form. With proper precautions and protocols in place, cancer treatment can be continued safely for most patients. There are basic measures all hospitals are taking like wearing masks/PPE, temperature screening and limiting caregivers and other visitors. Since most hospitals treat both COVID and non-COVID patients, some additional steps that should be taken are as follows
- The paths of entry, exits and even parking areas have to be separated for COVID (including suspected) and non-COVID patients. Even suspected and confirmed cases must not be allowed to mix under any circumstances
- There should be separate wards for all three categories of people – COVID positive, COVID suspected and COVID negative patients. The COVID testing unit should be separate and clearly delineated.
- Since COVID patients also undergo routine tests, there should be separate timings in the laboratories for different categories of patients.
- The air supply units and air handling units have to be adapted to meet the needs of mixed patient pool being treated at the hospital. Rooms housing COVID patients should have a minimum of 12 air changes per hour, all of which are exhausted directly to outside. The rooms should also be kept at a negative pressure, meaning that the corridor air is pulled into the room and then exhausted, further protecting the safety of others in the hospital. Hospitals can choose to opt for HEPA filters as the final filters in the HVAC system, which remove more than 99.9 per cent of these particles.
- There should be strict adherence to all cleaning protocols.
- Hospitals should create good SOPs for the staff and ensure strict supervision for implementing it.
- Training and repeated instructions to staff is critical to ensure that the processes are implemented seamlessly and habitually
- Well written posters with pictures should be put up at many places to serve as reminders to both patients and staff of the risk of coronavirus exposure and infection.
If a hospital does not have the infrastructure to implement all these measures, especially strict segregation between COVID and non-COVID zones, it might be safer and in the interest of the public to have certain hospitals designated as either purely COVID care centres or non-COVID treatment centres. The intense fear of contracting COVID in a hospital setting is causing people to delay seeking care and aggravating health conditions. With a disease like cancer, if a patient doesn’t feel safe and comfortable enough to visit the hospital, the risk to their health may be even greater as staying home delays their care. Therefore taking measures such as those listed above can help both oncologists and cancer patients to ensure optimal outcomes.
Oncologists are having to come up with other innovative ways to deal with the challenges posed by COVID-19. The question isn’t necessarily whether cancer treatment can or should be delayed on its own, but whether the risk of COVID-19 outweighs the risk of suspending cancer treatment. It’s a personal risk-benefit decision that oncologists should determine for each patient. Symptomatic patients or patients with progressive or active disease should be especially careful about treatment interruptions. Patients are advised to use telehealth technology, to determine which aspects of their care are safe to delay and which need to proceed.
For example, some patients undergoing intravenous chemotherapies may be safely placed on chemotherapies taken in pill form at home. In some cases, prognostic tests can be used to determine if the patient can completely avoid chemotherapy itself. For example, patients with early-stage breast cancer can undergo a test like CanAssist Breast to assess if they need chemotherapy or can directly start hormone therapy after surgery. Certain hormone therapies may also be continued at home, with doctors writing prescriptions to be filled at a local pharmacy and following up with regular telehealth visits.
One more important thing that oncologists and hospitals can do to adapt to the ongoing circumstances is to understand that cancer patients may be feeling overwhelmed and unsettled dealing with the double challenge of cancer and COVID. Offering mental health support via telehealth technology can help patients cope. Hospitals can start virtual support groups for cancer patients so that they can interact with others in similar situations and not feel so isolated.
Thus far, health care facilities and especially oncologists have had to face the challenges posed by the current pandemic on a war footing. There is a need for structural reforms for existing and future hospitals so that they create functional SOPs and infrastructure in order to tackle future outbreaks. Infections, small or big breakouts, epidemics and rare pandemics might become routine given the rapid rate of urbanisation and globalisation. Health facilities can work on preparedness protocols now so that they have ready made plans to deal with future uncertainties.