Even in this pandemic, the treatment of cancer can continue as previously. Advanced technologies like laparoscopy and robotic surgery can also be used.
CANCER - The word itself weakens the psyche and strength of many a strong people. The biggest reason for that is the fatal outcome traditionally associated with it in the past. However in the recent years, technological advances have improved the patient survival in early as well as some late cancers and has also improved quality of life in some terminal cancers.
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COVID-19 has wreaked havoc in the year 2020. With excess of 12.6 million cases worldwide and 850 thousand cases in India, it is here to stay for the next year at least. With no vaccine in sight, the travel restrictions, social distancing norms and other precautions will continue. This has led to a lot of hurdles in cancer care and treatment.
Cancer is considered a semi-emergency situation as delay in treatment can increase the stage of the disease or in some cases can even prove fatal.
In the initial stages of COVID-19, the triage process was used, wherein only the emergency cases were being operated upon. Initial studies from China had shown that patients with cancer did worse during the COVID era.
However, things have changed over the course of last few months. A landmark study published by the Tata Memorial Hospital has shown that there were no complications and outcomes were not worse in patients treated for cancer during the COVID-19 era. Another study which also supported continuation of cancer treatment during COVID-19 pandemic was a large study by Memorial Sloan Kettering from USA. This also showed that there were no worse outcomes in patient undergoing chemotherapy for cancer.
In view of this scientific evidence, cancer treatment has been started for our patients. Due precautions are taken to screen the patients and segregation of COVID positive and COVID negative patients is done.
The following policies help in management of cancer patients during this COVID-19 era.
1) Wherever possible, online video consultation is preferred for the patients especially following up for routine surveillance.
2) When on-site consultation is needed, patients are screened for symptoms of COVID-19 and patient is evaluated in the OPD with due protective gear
3) Laparoscopic and robotic surgeries can also be done in selected cases with use of smoke evacuators, without any additional risk to patient or health care personnel.
4) For radiation, wherever possible hypo-fractionation protocols are used. This implies use of higher doses and higher frequency of radiation delivery, to finish the treatment in a shorter duration. In selected cases, this can mean just one visit per week for radiation or decrease in the duration of treatment from 5 weeks to 3 weeks.
5) Use of advanced procedures like HIPEC (heated intra-peritoneal chemotherapy) can be done in selected cases at centres of excellence.
6) Patients who have recovered from COVID do not have any additional complication rates or prolonged ICU or hospital stay. Most of them will have the same post-operative course like a patient without COVID.
Thus, even in this pandemic, the treatment of cancer can continue as previously. Advanced technologies like laparoscopy and robotic surgery can also be used. Complex surgeries can be considered with due diligence.
In these pandemic times, for cancer treatment, the saying by famous Cathaginian general Hannibal, hold true : "Aut viam inveniam aut faciam" - "I will either find a way or make one"
Dr. Ninad Katdare.
Surgical Oncologist.
Specialist in Robotic and MAS
Specialist in GI, Gynaec and Perioneal Oncology.
Contact: 9769172789
email : ninad.katdare@humaneoncology.com.
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