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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2020; 41(02): 103-109
DOI: 10.4103/ijmpo.ijmpo_162_20
Editorial Commentary

Tale of Constant Adaptation, Revision, and Change of Cancer Therapy during the Ongoing COVID Crisis: Adapting to Cope and Win

Rima Pathak
Department of Radiation Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Garvit Chitkara
Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Padmaj Kulkarni
Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
,
Gouri Shankar Bhattacharyya
Department of Medical Oncology, Salt Lake City Medical Centre, Kolkata, West Bengal, India
,
Sudeep Gupta
Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
,
Jyoti Bajpai
Department of Medical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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In the year 1918, there was influenza pandemic, wherein India had the largest number of cases (10–20 million) among all the countries and had the highest case fatality ratio (4.39%) worldwide.[1] The total magnitude of estimated deaths globally was 50–100 million. A mathematic model predicted that if similar severity of influenza pandemic would have repeated in 2004, the estimated mortality toll world over would have been 62 million, and with a similar trend as in the past, nearly 14.8 million deaths were estimated in India alone.[2], [3]

In the wake of a similar pandemic of COVID-19 causing chaos all around the world and claiming thousands of lives, we need to introspect our current position and understand our capacity to “bend the curve” to minimize the magnitude of damage at every cost.[4], [5] Fortunately, so far, the situation in India appears better in comparison to many other countries, but the balance is dynamic. Cancer is a disease of the aging and therefore, many of our cancer patients are old. Unfortunately, the severity of COVID-19 illness is also maximum in the elderly and those with comorbid conditions such as uncontrolled hypertension or diabetes and cancer.[1] Hence, to reduce the impact of COVID-19, it is our joint responsibility as oncologists to explicitly communicate our deficiencies, efficiencies, and the ongoing challenges in treatment delivery and come to a consensus as a multidisciplinary team on where we think is most appropriate to draw lines and decide on consistent treatment policies, which are in alignment with the international guidelines, organization's capacity, and safe practices.[2]

The great inventions in the medical fields of public health, critical care, and emergency medicine such as vaccines, extracorporeal membrane oxygenation, several antibiotics, antivirals, and targeted therapy have failed to cure critical patients suffering from COVID-19, bolstering the ideology of “Prevention is still better than cure.”[3] Prevention of infection can only be achieved with population-based interventions such as quarantine of the suspected, isolation of the infected, and social distancing to reduce the cross contamination and improving hygiene to eventually “Flatten the otherwise exponentially rising curve of the infected cases.”[4], [5] The ultimate goal is to control the pandemic globally and epidemic locally (the strains of the viruses have been found to be different in different countries) by developing of herd immunity but in a controlled manner so as to not overwhelm the health-care sector.[6]

Execution of cancer care during the COVID-19 outbreak requires the oncologist to strike a fine balance between selection of treatment that provides meaningful life years and the treatment-related toxicities that make the patient more vulnerable to severe infection of SARS-CoV-2, leading to avoidable mortality.[7] While it may still be comparatively easier for a multidisciplinary cancer care team to come to a consensus on withholding standard treatments, this process becomes challenging through involvement of patients in this decision-making to strike this fine balance.[8] A pandemic is a protracted dynamic event which can change the existing situations by the day and that can be complicated by a variety of factors other than the virulence such as the region's social, political, and ethical considerations.[9] Hence, the action plans that may be valid today may not hold in future and due cognizance has to be paid to that uncertainty when deciding a road map.[9] Hospitals need to follow the new standards of care developed during the crisis and provide room to adjust them based on the changing volume of patients and severity of infection to successfully triage care.[4], [10], [11], [12], [13]



Publication History

Received: 15 April 2020

Accepted: 19 May 2020

Article published online:
23 May 2021

© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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