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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 3  |  Issue : 5  |  Page : 1-2

Catch-22: COVID versus Cancer


Department of Medical Oncology, Tata Memorial Center; Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission09-Apr-2020
Date of Acceptance10-Apr-2020
Date of Web Publication25-Apr-2020

Correspondence Address:
Vanita Noronha
Department of Medical Oncology Tata Memorial Hospital, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_145_20

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How to cite this article:
Noronha V, Behel V. Catch-22: COVID versus Cancer. Cancer Res Stat Treat 2020;3, Suppl S1:1-2

How to cite this URL:
Noronha V, Behel V. Catch-22: COVID versus Cancer. Cancer Res Stat Treat [serial online] 2020 [cited 2020 May 30];3, Suppl S1:1-2. Available from: http://www.crstonline.com/text.asp?2020/3/5/1/283308



“The enemy,” retorted Yossarian with weighted precision,“is anybody who's going to get you killed, no matter which side he's on, and that includes ______ (cancer and COVID). And don't you forget that, because the longer you remember it, the longer you might live.”

(Catch-22, Joseph Heller, 1961)

The common enemy as far as oncologists are concerned, is, was, and has always been cancer. Recently, along with the entire universe, we have acquired a deadly new enemy, which is perhaps feared even more than cancer: COVID-19. There is so much we do not know about SARS-CoV-2, and so much we are in the process of learning. The COVID pandemic has changed almost all aspects of life, medicine, and cancer care in unimaginable ways. As cancer doctors, the most pressing question is not, “What is the best treatment?” anymore; it has become, “Should I treat this patient now or defer therapy until the pandemic settles?” and “How can I modify the cancer treatment to minimize my patient's risk of COVID?” On the flip side, patients and caregivers have numerous concerns: Getting the best possible cancer care, protecting themselves from COVID, where to buy masks from, should they take hydroxychloroquine or any other medication to mitigate risk, and specific to the lockdown in India-how to arrange travel, shelter, food, medicines, money, and emotional support. Most organizations have recommended that we evaluate the urgency of therapy, delay elective treatment, proceed with therapy for emergency and life-threatening conditions, and modify existing treatments. This has required a major shift in mindset for most of us. Cancer therapy has never been elective; rather, it has always been at the very least urgent, if not an emergency. How do we prioritize among our patients and decide who should receive treatment now and whose treatment can be deferred? Although we do not have the exact answer to this, we have spent the last few weeks speaking to oncologists and other stakeholders all over India and getting advice and perspectives to help us understand how best to navigate the current crisis.

As a journal, our raison d'être is to disseminate timely and authentic information. Thus, our natural response in this crisis was to gather, collate, and disseminate as much information about COVID in our cancer patients as possible. There were many ideas, and finally, we put together the current issue that is in front of you. While planning this issue, we understood that our practice of oncology has been impacted during this pandemic in myriad ways. We also realized that there are limited data to help us measure the entire impact of the pandemic on oncology care. While interacting with our colleagues, we were convinced that everyone has tried to modify the care of cancer patients with good logic, many times with fair evidence and always with patient safety and welfare as the driving force. There was also a fair amount of interest during these virtual interactions regarding the possibility of putting together these modifications as references, which may help many oncologists, patients and caregivers.

History has taught us that we need to innovate and modify our practice during a crisis. Good examples of this approach were the guidelines for the use of intravesical Bacillus Calmette-Guerin in bladder cancer by the National Comprehensive Cancer Network (NCCN) and modification of the NCCN guidelines during the leucovorin crisis. In this issue, we have included several opinion pieces and review articles from eminent oncologists to help guide us in the way we practice oncology during the COVID pandemic. Our authors have provided some alternatives in cancer care to help us tailor our practice, especially in situations where the regular standard-of-care practice is not possible due to various reasons in the present circumstances.

We need to applaud and appreciate the efforts put in by the authors, the reviewers and the editorial team; putting together this issue in such a short time and that too at a time when we have all been so stressed was not easy. We request our readers to understand that these are opinion pieces and literature reviews. Due to the rapidly evolving situation, the evidence is being gathered in a unique way. We can all take away different aspects of these articles to our clinical practice depending on the situation of our patients. We want to emphasize that the articles in this issue should not replace or substitute the regular standard guidelines for oncology practice.

We request your feedback on this issue. We thank our authors and readers. We also pray with you that we emerge from this crisis with the least damage possible. Last but perhaps, the most important, we all need to emphasize the need for continued social distancing, hand wash practices, and wearing protective ancillary gear, including masks.

“Goodbye, Yossarian, and good luck. I'll stay here and persevere, and we'll meet again when the fighting stops.”

“How do you feel, Yossarian?”

“Fine. No. I'm very frightened.”

“That's good. It proves you're still alive.”






 

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