Opinion statement
While emergency use is authorized for numerous COVID-19 vaccines and the high-risk population including cancer patients or those with immunosuppression due to disease or therapy is prioritized, data on this group’s specific safety and efficacy of these vaccines remains limited. Safety data from clinical trials and population data may be extrapolated, and these vaccines may be used for cancer patients. However, concerns of efficacy due to the variable immune response in patients with active cancers undergoing active therapy and cancer survivors with chronic immunosuppression remain. The authors aim to discuss the current recommendations for use of COVID-19 vaccination in patients with cancer.
In the wake of the COVID-19 pandemic, due to reasons beyond control, health care workers have struggled to deliver treatment for the patients with cancer. The concern for otherwise healthy patients with curable cancers that require timely intervention or therapy is the risk of contracting COVID-19 may outweigh the benefits of cancer treatment. Lack of international guidelines leaves health care providers with a case-to-case approach for delivering optimal cancer care in the wake of the pandemic. Transition to telemedicine has somewhat bridged the gap for in-office visits, but there is a continuing challenge of delays in cancer screening or significant decline of new diagnoses of cancers due to the pandemic. We aim to propose a balance in risk from treatment delay versus risks from COVID-19 with emphasis on treatment modality (surgery, radiation, and systemic therapy) as well as supportive care for cancer patients, and therefore have reviewed the publications and recommendations from international societies and study groups available as of October 2020.
Convalescent plasma therapy has been extensively used across the world and is believed to save the lives of COVID-19-positive patients. The early preprint release of ICMRs PLACID study results has set the cat among the pigeons. This study consisted of 464 patients across 25 cities in India, involving both government and private hospitals. Methodology and results have valid points on both sides of the argument. Its publication in a peer-reviewed journal is awaited so that the details can be ascertained accurately. In the meantime, CTP should not be denied to COVID-19 patients. We share our current practical recommendations for its use. AmberHealth.in is providing an excellent platform to connect patients to potential nearby donors in real-time. This is a simple, intuitive, and free website connected to various social media that has been developed as a service to society by Dr. Tanvi Sood and Mr. Nikhil Joy.
The COVID-19 pandemic has hampered health-care delivery, with non-emergent consultations and surgical procedures being brought to a standstill. However, a delay in comprehensive cancer care may result in disease progression and poorer outcomes. Surgical oncology residents often form the front line responders for cancer patients, but now also have to function outside of their specialty to serve in COVID-19 units. With the uncertainty and unpredictability of this pandemic, surgical oncology residents find themselves at a crossroads. The need to keep abreast with COVID-19 treatment guidelines and recommendations comes at the expense of their surgical training. There is also a rising concern about personal safety, wellness, psychosocial well-being, and burnout. We highlight various elements concerning residents and suggest strategies that may be undertaken to allay anxiety and fatigue and facilitate surgical education.
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