|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 346-347
Karpe et al.'s reply to Chandrasekharan et al. and Bagal et al.
Ashay Karpe1, Sunila Nagvekar-Karpe2
1 Consultant Medical Oncologist, Hematologist and Stem Cell Transplant Physician, S L Raheja (Fortis) Hospital and HCG Hospital, Mumbai, Maharashtra, India
2 Consultant Pediatrics, Sterling Hospital and Apex Hospital, Mumbai, Maharashtra, India
|Date of Submission||14-May-2020|
|Date of Decision||15-May-2020|
|Date of Acceptance||16-May-2020|
|Date of Web Publication||19-Jun-2020|
Aarya Clinic, Shop No 1, Ganjawala CHS, Near Pai Nagar Garden, Off SVP Road, Borivali (West), Mumbai - 400 092, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Karpe A, Nagvekar-Karpe S. Karpe et al.'s reply to Chandrasekharan et al. and Bagal et al. Cancer Res Stat Treat 2020;3:346-7
We thank Bagal et al. and Chadrasekharan et al. for their knowledgeable and thought-provoking insights. The coronavirus disease-2019 (COVID-19) pandemic has changed the way we look at our current guidelines in all aspects of medicine, and oncology is no exception to this rule. As the situation is evolving rapidly every day, our approach toward our patients cannot be determined by a single set of guidelines. Therefore, we need to amend these guidelines dynamically according to the situation.
The challenges the entire medical community are facing are just as novel as the coronavirus itself. Currently, it is very difficult to have evidence-based guidelines to administer chemotherapy or any other treatment to patients with cancer. At times, clinicians might face unique situations in which they do not have definitive answers for what course of treatment should be followed. As mentioned by Chadrasekharan et al. about the pulmonary symptoms of bleomycin toxicity and the subsequent confusion about a possible coronavirus infection, we may come across cases where timely intervention will be required.
A predominant fear is that COVID-19 can increase the risk of mortality due to non-COVID causes, as suggested by Bagal et al. As such, the incidence of bleomycin-induced pulmonary toxicity is about 10%, while mortality associated with it is about 10%–20% accounting for 2%–3% of the patients treated with bleomycin. Meticulous pre-chemotherapy assessment and avoiding bleomycin in high-risk patients, such as chronic smokers or those with underlying lung diseases, could be a good way to identify the right candidates.
Bagal et al. have raised a valid point about deviation from standard care and its medicolegal implications. In due course, we have realized that this pandemic is going to be around for a while, and we need to treat our patients in the right window of time to get the best possible results. We concur with the authors that a delay in treatment or inability to deliver proper treatment is detrimental to patients with cancer.
In such an unpredictable situation, to outright deny treatment or hastily start or indefinitely postpone treatment under a blanket rule is also fraught with its own set of complications. Our article was not to promote any guidelines but was primarily a brainstorming of ideas to manage patients in these difficult times., We believe that rather than guidelines, the future will be more about personalized therapy tailored to each patient's medical and social condition at that point of time. In the absence of guidelines, any deviation from the standard protocol will come with its own set of medicolegal implications.
Until we have generated evidence-based guidelines for treatment, we must counsel each patient on a case-to-case basis about the pros and cons of modified treatment protocols versus standard guidelines, prognosis on chemotherapy versus susceptibility to COVID-19, complications, requirement of emergency hospitalization, and transport facilities for the same. As the situation evolves, oncologists all over the world will have to pool their data from these trying times and arrive at new consensus guidelines. Academic and research institutions will play a major role in formulating these guidelines. Until we reach such a consensus, obtaining detailed informed (positive or negative) consent from patients or their caregivers is the only viable solution.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Bagal B, Munot P, Nayak L. COVID-19 in hematological malignancies. Cancer Res Stat Treat 2020;3:345. [Full text]
Chandrasekharan A, Sreelesh KP, Gangadharan KV. Hematological malignancies in the time of COVID-19. Cancer Res Stat Treat 2020;3:343-4. [Full text]
Tomás R, Clarissa S, Frederico A
. Review Article- Bleomycin-induced lung injury. Hindawi Publishing Corporation. J Cancer Res 2013;2013:9.
Karpe A, Nagvekar-Karpe S. Management of hematological malignancies during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:54-8.
Philip CC, Devasia AJ. Treating hematolymphoid malignancies during COVID-19 in India: Challenges and potential approaches. Cancer Res Stat Treat 2020;3 Suppl S1:59-64.