|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 330-331
COVID-19 and thoracic cancers: A balancing act
Sabita Jiwnani, Devayani Niyogi, Virendra Tiwari
Department of Surgical Oncology, Division of Thoracic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
|Date of Submission||09-May-2020|
|Date of Decision||11-May-2020|
|Date of Acceptance||12-May-2020|
|Date of Web Publication||19-Jun-2020|
Department of Surgical Oncology, Division of Thoracic Surgery, Tata Memorial Hospital, Parel, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jiwnani S, Niyogi D, Tiwari V. COVID-19 and thoracic cancers: A balancing act. Cancer Res Stat Treat 2020;3:330-1
We read with interest the article by Menon et al. elucidating the various challenges faced by oncologists treating patients with lung and esophageal cancers during the coronavirus disease 2019 (COVID-19) pandemic. Since the publication of this review, the numbers have significantly worsened globally, with 3,916,338 patients being infected with the virus and 270,711 attributable deaths. It is becoming increasingly clear that the threat of COVID-19 is here to stay and may define the new “normal” for the next couple of months at the very least. It is, therefore, imperative to develop strategies to optimize cancer care in this era.
The challenges in dealing with thoracic malignancies in this setting are somewhat unique. As the authors have rightly pointed out, patients with lung cancer are not only at a higher risk of developing COVID-19 but also likely to have a more complicated course , in view of the underlying lung pathology and overlapping symptomatology., The authors have clearly elucidated issues faced by the patients in advanced stages of cancer and have proposed guidelines that can be followed for their optimal treatment.
A smaller but very important subset of patients with lung and esophageal cancers present at an early, potentially curative stage. They have a chance at long-term survival if treated in a timely and appropriate manner. Fine-tuning the treatment plan for these patients to effectively balance the risks and benefits is of paramount importance. After appropriate staging, comorbid conditions and the patients' functional status are the most important determinants of the treatment plan. Both these factors have the potential to severely influence the patient outcomes amid this outbreak. In turn, they have a direct impact on the utilization of precious hospital resources, such as the intensive care units (ICUs) and ventilator facilities. Treatment decisions need to be highly personalized. For example, in a fit patient, consideration can be given to upfront surgery for a resectable N2 (involvement of the ipsilateral mediastinal lymph nodes) lung cancer rather than neoadjuvant chemotherapy, as evidence has not found much difference between the two approaches. Early (T2N0 or less) esophageal cancers should be correctly identified and can be operated up front without much delay. A careful history of symptoms and potential exposure to COVID-19 is imperative, especially in centers that deal with a significant population of migrant patients. As COVID-19 can also lead to an asymptomatic infection, many centers prefer preoperative testing, though a negative test still mandates strict universal precautions. The patient and their caregivers should be involved in the decision-making process from the first visit, and consent for treatment should include the provision for a higher chance of complications in view of the COVID-19 outbreak.
Guidelines from various oncological societies have emphasized on personalizing the care of patients with cancer according to the phase of the epidemic in a particular region. Central to the theme are:
- Minimizing patient travel and hospital visits 
- Screening and selective testing for COVID-19
- Prioritizing treatment for potentially curable disease and imminent life-threatening conditions.
In these challenging times, it has become ever so relevant to abide by the guiding principle of medicine: Primum non nocere.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Menon N, Noronha V, Joshi A, Patil V, Prabhash K. Systemic therapy for thoracic malignancies during the COVID19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:29-34.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al
. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. Lancet Oncol 2020;21:335-7.
Calabrò L, Peters S, Soria JC, Di Giacomo AM, Barlesi F, Covre A, et al
. Challenges in lung cancer therapy during the COVID-19 pandemic. Lancet Respir Med 2020. pii: S2213-2600(20)30170-3.
Felip E, Rosell R, Maestre JA, Rodríguez-Paniagua JM, Morán T, Astudillo J, et al
. Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small-cell lung cancer. J Clin Oncol 2010;28:3138-45.
Srivastava P, Tilak TV, Patel A, Das CK, Biswas B, Mahindru S, et al
. Advisory for cancer patients during the COVID pandemic. Cancer Res Stat Treat 2020;3, Suppl S1:145-8.