Cancer patients must learn to treat the post-COVID-19 world as a ‘new normal,’ and remain focused on what they need to do to manage their illness within it. Healthcare providers and policymakers, for their part, must remain committed to providing cancer patients with the highest standards of care throughout.
Cancer patients are caught between a rock and a hard place in the face of the ongoing global pandemic — COVID-19. On the one hand, cancer patients are at risk of developing severe complications from COVID-19 because of their low immunity, and should ideally minimise the exposure to the outside world while the virus is active. On the other hand, even as governments tiptoe around easing lockdowns and other restrictions to contain the virus, we are unlikely to see a COVID-free world any time soon. A vaccine, which would be our best defence against the virus and the only real route to normalcy, is at least 12 to 18 months away, and the threat of virus resurgence could linger until 2024).
Most cancer patients can ill-afford to wait out a crisis of this length at home, or on telemedicine alone. Cancer treatment lines such as surgery, chemotherapy, and radiation therapy are typically time-sensitive and must be delivered swiftly, in clinical settings, to arrest the spread of cancer. If cancer is to be curable at all, furthermore, it must be detected early, which means being vigilant about initial signs, and seeking immediate care should there arise any. Ignoring cancer and its symptoms is dangerous, with serious long-term consequences for both patients and health systems.
If cancer is to be curable at all, furthermore, it must be detected early, which means being vigilant about initial signs, and seeking immediate care should there arise any.
There is only one way out the dilemma facing cancer patients, we suggest below. Difficult as it might be, cancer patients must learn to treat the post-COVID world as a ‘new normal,’ and remain focused on what they need to do to manage their illness within it. Healthcare providers and policymakers, for their part, must remain committed to providing cancer patients with the highest standards of care throughout, removing bottlenecks to access wherever possible.
Cancer in India — Adapting to a ‘New Normal’
While it is true that the age-adjusted incidence rates for cancer are still quite low — slightly more than one million new cases of cancer are diagnosed every year in a population of 1.3 billion — a large number of cancer deaths occur every year. In age-standardised terms, these are close to the mortality burden seen in high-income countries Notably, the mortality-to-incidence ratio in India is 0.68, which is far higher than what it is (approximately 0.38) in developed countries.
The grim reality in India is that majority of cancer cases are diagnosed in advanced stages, and two thirds of patients die as a result of the disease. The high death rate from cancer is attributable to many factors, such as poor science literacy and misinformation, which impede early detection, and inequitable healthcare distribution and access, which hinders not only early detection, but also treatment options. Addressing the root causes of high cancer deaths will be a major challenge, especially given that India’s cancer burden is projected to double in the next two decades.
The grim reality in India is that majority of cancer cases are diagnosed in advanced stages, and two thirds of patients die as a result of the disease.
In recent years, non-communicable diseases (NCDs) such as cancer have received more attention from Indian policymakers. Cancer care has slowly moved in the right direction, with new treatment centres and cancer awareness campaigns materialising across the country. It will be vital to safeguard these crucial advances in cancer care during the COVID pandemic.
In many parts of the world, coronavirus has been battering health systems and compromising care for cancer patients. In the UK, for example, even high-priority cancer patients have been left with cancelled chemotherapy and surgery appointments. In the United States, half of the cancer patients who responded to a recent survey by the American Cancer Society reported changes, delays, or interruptions to their care.
India has been lucky in this regard, at least so far. For reasons that remain unclear, we have managed to evade sort of the deluge of COVID-19 patients that has overwhelmed health systems in other countries (there are no definitive answers as to why the virus has devastated some places, such as New York and Northern Italy, while leaving others relatively unscathed). Remarkably, most healthcare providers in India have managed to keep their cancer services more or less intact.
While inadequate hospital provision has not (as of yet) been an obstacle for cancer patients during the COVID-19 crisis in India, other system-wide disturbances being generated by the pandemic are proving problematic.
This does not mean, however, that we can afford to be complacent. While inadequate hospital provision has not (as of yet) been an obstacle for cancer patients during the COVID crisis in India, other system-wide disturbances being generated by the pandemic are proving problematic. Policymakers, healthcare providers, as well as patients need to be aware of these so that they may more adeptly navigate post-COVID realities, taking corrective measures when necessary.
First, although the government has generally done a good job of facilitating safe passage for patients seeking medical treatment, the complex restrictions on inter- and intra-state travel as well as disruptions in public transport systems are likely to discourage cancer patients from seeking the treatment they need. This is a problem that will affect large numbers. The poor geographical coverage of medical services in India ( means that cancer patients often need to travel long distances in order to access reliable care. The need for safe, dependable modes of transport is especially urgent given that the burden of cancer is significantly higher among the elderly (70+) cohort in India.
Second, the financial fallout of COVID-19 is also likely to have a demoralising effect on cancer patients. Studies have shown that expenditure on cancer inpatient treatment is highest among all NCDs in India, with out-of-pocket expenditure on cancer hospitalisation about 2.5 times of overall average hospitalisation expenditure. Many people resort to distressed means for treatment financing such as the sale of household assets. The income and job losses that are following coronavirus containment measures across the world are playing out in India as well. In the absence of financial relief schemes, cancer patients and their families will be left with even fewer resources to pay for treatment.
The complex restrictions on inter- and intra-state travel as well as disruptions in public transport systems are likely to discourage cancer patients from seeking the treatment they need.
Third, while specialist oncology services have remained largely unaffected by the COVID crisis, the same cannot be said for primary healthcare, which has been hit by a massive diversion of resources to manage the pandemic. Since it is the primary healthcare practitioner who is first approached with complaints of symptoms that could be indicative of cancer, and who also holds the key to awareness-raising, screening and referrals, any malfunction at this level could have serious implications for the early detection of cancer. Since early detection is already a problem in India, policymakers must be careful not to compromise it further.
All of these dynamics, which are working to discourage cancer patients from seeking the treatment they need, are being fortified by another factor — an unreasonably intense fear of COVID. Such fear is leading patients and their caregivers to the incorrect assumption that they have no reliable means of protecting themselves from COVID-19, and that interacting with medical staff will only place them in graver danger. In reality, if sufficient precautions are taken, cancer care can be delivered — and is being delivered — quite safely. With the judicious use of personal protective equipment (PPE), for example, the risk of intra-hospital transmission of COVID-19 can be reduced substantially. While, admittedly, nothing will be 100 percent safe while the virus is still active, the odds of surviving cancer treatment are far better than the odds of trying to go without it. Indeed, the key to successfully navigating our new, post-COVID normal is not inaction, but careful risk assessment and continuous engagement.
