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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 343-344

Hematological malignancies in the time of COVID-19


Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Kozhikode, Kerala, India

Date of Submission07-May-2020
Date of Decision08-May-2020
Date of Acceptance08-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Arun Chandrasekharan
Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Mini Bypass Road, Govindapuram, Kozhikode - 673 016, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_175_20

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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

How to cite this URL:
Chandrasekharan A, Sreelesh K P, Gangadharan K V. Hematological malignancies in the time of COVID-19. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 27];3:343-4. Available from: https://www.crstonline.com/text.asp?2020/3/2/343/287223



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.[1],[2] The impact of the COVID-19 pandemic on the delivery of routine cancer care has been dealt with in detail, highlighting the risks involved.[3]

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%).[4] 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 [1],[2] 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.[5] 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.[6] 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 [1],[2] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Karpe A, Nagvekar-Karpe S. Management of hematological malignancies during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:54-8.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Bansal N, Ghafur A. COVID-19 in oncology settings. Cancer Res Stat Treat 2020;3 Suppl S1:13-4.  Back to cited text no. 3
    
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.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
Coronavirus Highlights: Leaves Cancelled, Health Ministry Asks Hospitals to Prepare for Drill on Sunday - The Economic Times. The Economic Times. Available from: https://economictimes.indiatimes.com/news/poli tics-and-nation/coronavirus-cases-in-india-live-ne ws-latest-updates-march20/liveblog/74721738.cms. [Last accessed on 2020 May 04].  Back to cited text no. 6
    



This article has been cited by
1 Philip et al.ęs reply to Chandrasekharan et al. and Bagal et al.
ChepsyC Philip,AnupJ Devasia
Cancer Research, Statistics, and Treatment. 2020; 3(2): 347
[Pubmed] | [DOI]
2 Karpe et al.ęs reply to Chandrasekharan et al. and Bagal et al.
Ashay Karpe,Sunila Nagvekar-Karpe
Cancer Research, Statistics, and Treatment. 2020; 3(2): 346
[Pubmed] | [DOI]



 

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