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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 5  |  Page : 150-152

Impact of COVID-19 outbreak on peripheral cancer clinic services


Department of Preventive Oncology, Homi Bhabha Cancer Hospital and Research Center (HBCHRC), Muzaffarpur, Bihar, India

Date of Submission04-Apr-2020
Date of Decision07-Apr-2020
Date of Acceptance09-Apr-2020
Date of Web Publication25-Apr-2020

Correspondence Address:
Ravikant Singh
Assistant Professor, Preventive Oncology Department, Homi Bhabha Cancer Hospital and Research Centre, Muzaffarpur, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_121_20

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How to cite this article:
Singh R, Ishan R. Impact of COVID-19 outbreak on peripheral cancer clinic services. Cancer Res Stat Treat 2020;3, Suppl S1:150-2

How to cite this URL:
Singh R, Ishan R. Impact of COVID-19 outbreak on peripheral cancer clinic services. Cancer Res Stat Treat [serial online] 2020 [cited 2020 May 30];3, Suppl S1:150-2. Available from: http://www.crstonline.com/text.asp?2020/3/5/150/283292



India reported its first COVID-19 case on January 30, 2020, and since then, the disease is rapidly making its presence felt in the region. As of today, there are more than 3127 cases of COVID-19, with 86 deaths in the country.[1] India imposed a nationwide lockdown for 21 days on March 24, 2020,[2] and since then, the routine medical facilities have been disrupted.

According to GLOBOCAN 2018, every year, more than 1.1 million new cases of cancer are diagnosed in India along with 0.78 million deaths.[3] The majority of these patients come from the rural areas across India with limited cancer care facilities. Patients with cancer are particularly susceptible to COVID-19 and have increased chances of worse outcomes such as death from infection or severe pneumonia. A study conducted in China using data from a small number of patients showed that patients with cancer who were also infected with the novel coronavirus had deteriorating conditions and poor outcomes. More than half (53.6%) of the patients developed severe complications and 28.6% of the patients died.[4]

The Tata Memorial Center[5] in Mumbai, India, is a grant-in-aid institute under the department of atomic energy that has established many new peripheral cancer hospitals to cater to the needs of patients with cancer. One of the peripheral centers is established in the Muzaffarpur district of Bihar, providing preventive oncology, basic diagnostics, telemedicine services, and a population-based cancer registry (PBCR). After the COVID-19 outbreak, the routine workflow at our center got disrupted in multiple ways, and we faced many challenges in running the outpatient department (OPD) and other services.

Immediately after the lockdown, we faced the following challenges in our routine functioning.

  1. Difficulty in moving our staff to the center as all local transport services were closed
  2. Essential consumables and personal protective equipment (PPE) could not reach the center
  3. Patients were unable to access the cancer center for routine follow-up or diagnostic checkups
  4. Patients from poor socioeconomic backgrounds were not able to avail of an ambulance or any private vehicle due to the lack of money as well as higher rental charges post lockdown
  5. The treatment of many patients requiring chemotherapy was on hold as transportation services were not available, and many higher centers had stopped giving chemotherapy to patients
  6. The number of patients coming to the OPD decreased drastically
  7. We were unable to call the patients for the weekly teleconsultations with specialists at the Tata Memorial Hospital, Mumbai, or Homi Bhabha Cancer Hospital, Varanasi
  8. Many patients were unable to get chemotherapy drugs from the market as they were out of stock
  9. Patients who were receiving palliative care particularly faced problems in getting basic symptomatic care, pain relief, or procedures done, as even the private health-care facilities were closed; only a few big hospitals had their emergency departments functioning
  10. There was anxiety and concern among the health-care staff regarding their own safety and shortage of PPE to run the OPD and outreach activities
  11. The on-field data collection by the PBCR team members was totally suspended as they were not able to move out of their home
  12. All civil work related to upgradation of the cancer center was also put on hold because of the lockdown and unavailability of workforce and materials.


Under these circumstances, running the services was challenging, but the staff tried their best to keep them running. We made the following changes to continue providing basic cancer care services at Muzaffarpur:

  1. Reduced the number of staff to run the OPD services
  2. Issued a special pass for the movement of doctors and nursing staff
  3. Started teleconsultation for patients on follow-up
  4. Reduced the frequency of OPD days every week
  5. Provided PPE and encouraged rational use of PPE in the OPD
  6. Maintained social distancing in the OPD and did not allow more than 1 attendant to accompany a patient into the OPD
  7. Trained cancer care providers about the challenges of COVID-19 by means of online education and webinars.


Every state with a high number of patients with cancer should make contingency plans in advance to continue providing essential cancer care services during the time of the COVID-19 pandemic. Many mathematical predictions for India suggest that the COIVD-19 infection can go on for many months; one such prediction by the Center for Disease Dynamics, Economics and Policy (CDDEP) suggests that new cases of COVID-19 will keep emerging till September 2020 in India[6] [Figure 1] and [Figure 2].
Figure 1: Predicted infections from COVID-19 in India (taken from cddep.org)

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Figure 2: Predicted hospitalizations from COVID-19 in India (taken from cddep.org)

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Here are some key suggestions that can be considered while designing a contingency plan.

  1. Strengthen home-based palliative care services for critically and terminally ill cancer patients. A special vehicle or ambulance should be provided to each center handling such patients
  2. Health-care workers involved in cancer care services should be given a special permit to move around the district
  3. Strengthening the logistics for deployment of workforce, medicine, and material required for cancer care services during this pandemic
  4. OPD and emergency services for the patients with cancer should be functional throughout this pandemic with a limited number of staff on rotation while maintaining social distancing
  5. PPE should be provided to all health-care personnel involved in cancer care services. Special attention should be given to hand hygiene practices of the health-care workers
  6. PPE like N95 mask can also be given to patients on chemotherapy or those in an immunocompromised state
  7. Start teleconsultation facility for patients living in remote villages/blocks to eliminate the need for their physical presence at the hospital
  8. OPD or diagnostic timings can be changed to limit the exposure of patients on chemotherapy to other patients coming to the hospital. Not more than one attendant should be allowed inside the cancer center after thermal screening of the attendant
  9. Limit the outreach activities of the team members to essential services only to prevent them from risk of exposure to asymptomatic cases in the community.


In summary, we would like to emphasize that patients with cancer are the ones who are highly vulnerable in this COVID-19 pandemic,[7] and states such as Bihar should have a separate plan so that these patients can continue to avail of essential treatment while avoiding exposure to the novel coronavirus. Furthermore, there is a need for conducting extensive screening and testing for COVID-19 among patients with cancer if the pandemic spreads further in India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Available from: https://www.covid19india.org. [Last accessed on 2020 Apr 03].  Back to cited text no. 1
    
2.
Available from: https://www.bbc.com/news/world-asia-india- 52024239. [Last accessed on 2020 Apr 03].  Back to cited text no. 2
    
3.
Available from: https://gco.iarc.fr/today/data/factsheets/populations/356- india-fact-sheets.pdf. [Last accessed on 2020 Apr 03].  Back to cited text no. 3
    
4.
Available from: https://www.curetoday.com/articles/how-covid19- affects-patients-with-cancer. [Last accessed on 2020 Apr 03].  Back to cited text no. 4
    
5.
Available from: https://tmc.gov.in/tmh/index.php/en/. [Last accessed on 2020 Apr 03].  Back to cited text no. 5
    
6.
Available from: https://cddep.org/covid-19/. [Last accessed on 2020 Apr 03].  Back to cited text no. 6
    
7.
Bansal N, Ghafur A. COVID-19 in oncology settings. Cancer Res Stat Treat 2020;3:13-4.  Back to cited text no. 7
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