|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 343-344
Hematological malignancies in the time of COVID-19
Arun Chandrasekharan, KP Sreelesh, KV Gangadharan
Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Kozhikode, Kerala, India
|Date of Submission||07-May-2020|
|Date of Decision||08-May-2020|
|Date of Acceptance||08-May-2020|
|Date of Web Publication||19-Jun-2020|
Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Mini Bypass Road, Govindapuram, Kozhikode - 673 016, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chandrasekharan A, Sreelesh K P, Gangadharan K V. Hematological malignancies in the time of COVID-19. Cancer Res Stat Treat 2020;3:343-4
Two of the articles published in the recent issue of Cancer Research, Statistics, and Treatment discuss the issues involved in the management of patients with hematolymphoid malignancies during the current coronavirus disease 2019 (COVID-19) pandemic and offer advice on the same., The impact of the COVID-19 pandemic on the delivery of routine cancer care has been dealt with in detail, highlighting the risks involved.
To put things into perspective, according to a study from China (the epicenter of the pandemic), patients with cancer are more likely to have severe events such as intensive care admission, invasive ventilation, and death, than patients without cancer (39% vs. 8%). Patients who underwent a recent surgery or chemotherapy for cancer in the past month had more acute severe events than those who were on follow-up (75% vs. 43%). These data speak volumes about the difficult and sometimes uncertain decisions the clinicians have to face along with their patients, regarding the start or continuation of cancer-directed therapy.
Some of the practices that we have incorporated in our management of such patients include informing the patients and their caregivers about the risk of COVID-19 infections and associated increased mortality and getting all the involved parties to sign a consent form and elaborating all the details of therapy, risks involved, and requirement of sudden treatment changes during the course of therapy, according to the existing state of affairs. This helps in conveying the gravity of the situation during the pandemic along with providing us legal backup, especially in a litigious society such as ours.
One of the issues recently faced by us was when a patient with Hodgkin's lymphoma post two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy regimen presented to the outpatient department with dyspnea on exertion. His baseline oxygen saturation was normal, and he had no history of fever or a history of contact with a COVID patient. Computed tomography scan of the chest showed bilateral ground glassing, suspicious of bleomycin toxicity or viral pneumonitis. In view of the ongoing pandemic, an underlying suspicion of COVID-19 infection was entertained as well. As the patient was stable, he was sent home on oral steroids and advised to stay in quarantine along with his accompanying relative and inform us telephonically in case of any worsening of his condition. A COVID-19 test was not done as the patient did not qualify for it according to our institutional guidelines. In a tele-consultation done a few days later, we were told that the patient had recovered completely. It is always best to be over cautious in such circumstances.
Some of the oral targeted therapies discussed in the guideline articles , are currently unavailable in India. With transport infrastructure around the world crippled by the ongoing pandemic, even routinely available cancer drugs are difficult to procure, and this may lead to unavoidable delays or compromise in cancer care.
Our opinion differs from that of certain other countries on bringing in retired doctors to augment the workforce, as they would be among the vulnerable groups with an increased risk of mortality from COVID-19. In certain states in India, the leaves of all government doctors and health staff have been revoked, to strengthen the workforce of the frontline caregivers. Many others have voluntarily foregone their leaves and provided their service to the nation during this time of need.
This once-in-a-century event has derailed the well-established health-care systems and protocols and pushed us all into uncertainty. The framework and guidelines discussed by Karpe and Nagvekar-Karpe and Philip and Devasia , help to rationalize hematological cancer care amid the COVID-19 crisis. However, in these difficult times, difficult decisions will have to be made based on personal experience as well. “It is only in our darkest hours that we may discover the true strength of the brilliant light within ourselves that can never, ever, be dimmed.” – Doe Zantamata.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Bansal N, Ghafur A. COVID-19 in oncology settings. Cancer Res Stat Treat 2020;3 Suppl S1:13-4.
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.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al
. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.