Have Cancer Treatments Taken A Backseat During COVID-19?

World Cancer Day is observed every year on February 4 to create awareness, inspire change and reduce the global impact of cancer. The aim is to minimise misconceptions surrounding the disease and its prejudices to help people get the correct information. It also offers a chance to impact the betterment of the life of cancer patients and survivors. The theme of World Cancer Day 2022 is 'Close the Care Gap'. It is all about understanding and recognising the inequities in cancer care around the globe.

Cancer care has suffered during the pandemic due to the diversion of the workforce to treat patients infected with COVID-19. Lockdowns and restrictions on movement during the pandemic, difficulties in travel, and the fear of contracting COVID have prevented most patients from accessing cancer care.

Non-communicable diseases account for nearly 63 per cent of the total deaths in India, and cancer at 9 per cent is one of the leading causes.

As many as 13,92,179 people in India had cancer in 2020, and the five leading sites of the disease are breast, head & neck, uterine, and lung.

Specialists point out that 94.1 in every 1,00,000 men are cancer patients in India, increasing to 103.6 in every 1,00,000 women. They feel that the country needs to take a proactive approach towards reducing this burden.

Various predictions said that the stagnation of patients inflow and treatment lead to increased cancer burden due to patients presenting later at advanced stages of the disease.

Reduction In New Patients

In a study published in one of the top international journals done across the 41 cancer centres in India, there was almost a 50% reduction in the number of new patients attending cancer clinics or follow-up visits of patients. A tremendous drop in the number of significant surgeries being performed was witnessed, and daycare chemotherapies were being administered.

"What was more alarming to see was that cancer screening which enables detection of the disease at an early stage was almost stopped or functioning at 25% of usual capacity. These findings were predominantly seen during the first pandemic wave in 2020," Dr Shabber Zaveri, Consultant in Surgical Oncology, Manipal Hospital Bengaluru, told The Logical Indian.

A predictive modelling study predicted that 59.7% of cancer surgeries were postponed during the peak 12 weeks of lockdown, which later added to the cancer burden.

Treatment Delays

According to a study published in the Asian Pacific Journal of Cancer Care, disease progression may hamper curative intent treatment and require more aggressive therapy, indirectly contributing to increased cancer burden. As per the study, 50% of the patients had disease progression during evaluation, with 15% (6 patients) progression to distant metastasis.

The study revealed that patients with head neck/lung primary had progression in 56.5% (13/23), whereas patients with other primary sites had progression in 41.18% (7/17).

Cancer treatment in most instances involves a multidisciplinary approach of surgery, radiation, and chemotherapy/targeted therapy. Hence, there is a significant amount of financial burdens that patients and their families need to undergo, magnified during the last two years due to the economic slowdown and the resultant impact on job opportunities. In many instances, loss or change in jobs due to migration during the pandemic, insurance cover provided by employers was not available for patients and their families.

Among the response to the cause of delay in visiting treatment facilities, most patients said "high cost of transportation"(45%). Nearly 69% of patients treated with radiotherapy responded either "high cost of transportation" or "lack of proper accommodation facility". The study said that other socio-economic factors like education, geographical location, etc., have played a part in decision-making.

"This led to instances where cancer became advanced and progressed to Stage 4 disease and became incurable. Furthermore, many patients missed their follow-up visits which led to recurrences being detected later with hazardous consequences. Hence policymakers and institutes need to have protocols and facilities to continue cancer treatment during the pandemic," Dr Zaveri said.

Many studies done before the deployment of vaccination against COVID showed that patients with cancer had a more severe form of COVID-19, particularly those who suffered from blood cancer or had lung cancer, or had advanced and progressive cancer.

Tumour Progression

Meanwhile, a very recent study indicated that patients with cancer and COVID-19 hold risk for tumour progression. These findings explain the worsened outcomes in patients suffering from cancer and COVID, making it essential for increased vigilance as part of the ongoing follow-up of COVID-19.

Concerning the impact of COVID-19 on cancer, there are theoretical hypotheses that an increase in inflammatory pathways and other cytokines might promote tumour progression. "However, we only have a few case reports of patients who have been cured of cancer but have been detected to have a recurrence following COVID-19 infection. Most of the worsening of cancer has been due to logistical factors such as delay in treatment or inaccessibility to treatment," Dr Zaveri explained.

According to the GLOBOCON 2020 data, there is an increase in cancer presentation at a younger age, but only 1/3 get detected at an early stage.

"There is a general increase in awareness about the disease. Cancer management has become more advanced in the country in the last decade with robotic surgeries, availability of immunotherapy and targeted therapy and molecular sequencing of tumours. India can become the leader in cancer care in the coming decades. We need collaboration between scientific institutes to drive research in this field," Dr Zaveri concluded.

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