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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 349-350

Author's reply to Sekhar


Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India

Date of Submission09-May-2020
Date of Decision11-May-2020
Date of Acceptance11-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Rakesh Pinninti
Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_186_20

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How to cite this article:
Pinninti R. Author's reply to Sekhar. Cancer Res Stat Treat 2020;3:349-50

How to cite this URL:
Pinninti R. Author's reply to Sekhar. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 12];3:349-50. Available from: http://www.crstonline.com/text.asp?2020/3/2/349/287232



I thank Dr. Sekhar for his valuable comments on the review article titled, “Management of geriatric cancer patients during coronavirus disease 2019 pandemic.”[1],[2] With this reply, I would like to reiterate the importance of a comprehensive geriatric assessment (CGA) for clinicians taking care of geriatric oncology patients, to objectively assess the various functional domains, thereby mitigating the several inherent biases that may negatively impact the clinical outcomes in these patients.[3],[4] Once a CGA effectively clears the patients for consideration of cancer-directed therapy, there should be no room for ethical dilemmas regarding restrictions or modifications to therapy plans, withholding care, and consideration for palliative care based on the chronological age alone. If any such dilemma arises, it should not be unique to the older patients with cancer.

As mentioned in the review article, every attempt should be made to modify the cancer-directed therapy to limit the number of hospital visits, such as altered fractionated radiotherapy;[5] oral substitutes, where feasible; and as suggested by the authors, extended schedule immunotherapy (either 4-weekly nivolumab or 6-weekly pembrolizumab).[6],[7] However, care should be exercised to base such decisions on clinical evidence of non-inferior outcomes with modified therapy schedules, and clinicians should adhere to dosing as proposed in the regulatory approvals.

I agree with the author's assertion on the importance of general geriatric care in the form of seasonal flu and other vaccinations. This might help in reducing the background noise of other infections in this tumultuous period, where every minor lower or upper respiratory tract infection creates panic possibly leading to an emergency room visit and causes unnecessary exposure to the healthcare system, which is already burdened with the ongoing pandemic situation. As a result of the uncertain trajectory of the coronavirus disease 2019 (COVID-19) pandemic, all older individuals, particularly those with comorbidities, should be adequately informed about all the infection control measures, including vaccinations; however, these measures are a part of the standard geriatric medical care even during the nonpandemic clinical practice.[8]

Despite years of neglect and exclusion from clinical trials, the time is ripe to address and emphasize the importance of inclusion of geriatric patients in several clinical trials trying to identify the “magic bullet” against COVID-19. As mentioned by the authors, several drugs and investigational therapies are being proposed,[9],[10],[11] and the efforts should be made to involve the geriatric patients as a priority population for testing their safety and efficacy.

Finally, I agree with the author's observation of the greater psychological impact of the viral pandemic on the older patients. Clinicians and society at large should understand the true concept of “physical distancing,” which is not necessarily a social isolation, especially with regard to the older people.[12] Digital technologies should be harnessed to reduce the disproportionately negative impact on the older patients due to the reduced access to physical and mental care during the ongoing pandemic.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sekar A. Approach to geriatric oncology patients during the coronavirus disease 2019 pandemic: A changing treatment paradigm. Cancer Res Stat Treat 2020;3:348-9.  Back to cited text no. 1
  [Full text]  
2.
Pinninti R. Management of geriatric cancer patients during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:71-5.  Back to cited text no. 2
    
3.
Noronha V, Talreja V, Joshi A, Patil V, Prabhash K. Survey for geriatric assessment in practicing oncologists in India. Cancer Res Stat Treat 2019;2:232-6.  Back to cited text no. 3
  [Full text]  
4.
Noronha V, Ramaswamy A, Dhekle R, Talreja V, Gota V, Gawit K, et al. Initial experience of a geriatric oncology clinic in a tertiary cancer center in India. Cancer Res Stat Treat 2020;3:208-17.  Back to cited text no. 4
  [Full text]  
5.
Munshi A, Rastogi K. Management of cancer during the COVID-19 pandemic: Practical suggestions for the radiation oncology departments. Cancer Res Stat Treat 2020;3 Suppl S1:115-8.  Back to cited text no. 5
    
6.
Lala M, Li TR, de Alwis DP, Sinha V, Mayawala K, Yamamoto N, et al. A six-weekly dosing schedule for pembrolizumab in patients with cancer based on evaluation using modelling and simulation. Eur J Cancer 2020;131:68-75.  Back to cited text no. 6
    
7.
Thomas VM, Mathew A. Immunotherapy during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:149-50.  Back to cited text no. 7
    
8.
Rubin LG, Levin MJ, Ljungman P, Avery R, Tomblyn M, Bousvaros A, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:309-18.  Back to cited text no. 8
    
9.
Batra U, Sharma M, Redhu P. Chloroquine and hydroxychloroquine: Clutching at straws in the time of COVID-19? Cancer Res Stat Treat 2020;3 Suppl S1:3-6.  Back to cited text no. 9
    
10.
Bhargava P, Panda P, Ostwal V, Ramaswamy A. Repurposing valproate to prevent acute respiratory distress syndrome/acute lung injury in COVID-19: A review of immunomodulatory action. Cancer Res Stat Treat 2020;3 Suppl S1:65-70.  Back to cited text no. 10
    
11.
Qayyumi B, Sharin F, Singh A, Tuljapurkar V, Chaturvedi P. Management of COVID-19: A brief overview of the various treatment strategies. Cancer Res Stat Treat 2020;3:233-43.  Back to cited text no. 11
  [Full text]  
12.
Dalal NV. Social issues faced by cancer patients during the coronavirus (COVID-19) pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:141-4.  Back to cited text no. 12
    




 

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