Caring for cancer patients in the Covid pandemic: choosing between the devil and deep sea
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(2020) 18:220
REVIEW
Open Access
Caring for cancer patients in the Covid pandemic: choosing between the devil and deep sea Mainak Chakraborty and Manoj Pandey*
Abstract Background: Healthcare is an essential service at any time more so in the crisis like Covid. With increase in number of cases and mortality from Covid, the primary focus is shifted to the management of the Covid crisis and other health emergencies thus affecting normal health services and routine treatment of other diseases like cancer. Methods: This article reviews the published literature and guidelines on Covid and cancer and discusses them to optimize the care of cancer patients during Covid pandemic to improve treatment outcomes. Results: The results of the review of published literature show a twofold increase in probability of getting CoV2 infection by the cancer patients and a four-fold increase in chance of death. On the other hand, if left untreated a 20% increase in cancer death is expected. Data further show that none of the medicines like remdesivir, hydroxy chloroquin, dexamethasone, or azithromycin improves survival and response to Covid in cancer patients. Surgical results too show similar outcome before and after the pandemic though most of these report on highly selected patients populations. Conclusions: The Covid 2019 pandemic places cancer patients in a very difficult situation wherein if they seek treatment, they are exposing themselves to a risk of developing CoV2 infection and if they do not, the probability of dying without treatment increases. Hence, for them it is a choice between the devil and deep sea, and it is for the healthcare providers to triage patients and treat who cannot wait even though the data from the carefully selected cohort of patients show no increase in mortality or morbidity from treatment during Covid. Keywords: Covid, Cancer, CoV2, Coronavirus, Treatment, Chemotherapy, Surgery
Introduction With the onset of Covid-19 pandemic, the situation for cancer patients has become a nightmare. Most of the patients who were on treatment in March had to miss out their further treatment due to lockdown and closure of hospitals and all modes of transport, both public and private. Those who developed cancer during lockdown too could not reach doctors for the same reason. Surgeries were postponed, radiotherapy was postponed, and there * Correspondence: [email protected] Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
was uncertainty as far as chemotherapy and immunotherapy were concerned. Every society and organization came up with their own guidelines; however, none of these addressed the logistic problems that patients faced reaching the treatment centers. This lead to an increased pool of untreated patients; an analysis from England estimates additional 6270 deaths from cancer over next 12 months that is 20% increase proposed due to Covid pandemic [1]. Those who were willing to travel and take the risk of getting infected with Covid-19, t
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