Impact of COVID-19 on cancer care in India: a cohort study

Abstract

Background The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. MethodsWe did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FindingsBetween March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities).Interpretation The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial.

COVID-19 pandemic and lock-down protocols: Impact in an indian tertiary cancer center

“…During this pandemic, health care resources have been redirected towards the treatment of COVID-19 patients [7] . For example, some of the cancer centers were converted to COVID-19 treatment facilities [8] . Due to travel restrictions and fear of exposure to the virus cancer screening, research, clinical trials were significantly impaired [5] , [7] …”

“…Globally, irrespective of income status, data show a downfall in the number of patients accessing cancer treatment. Delayed treatment will have a serious public health impact in the coming years, with a predicted surge in the mortality rate within the next 5-10 years [8] . To assess the impact of COVID-19 and nationwide lockdown protocols, we assessed the changes in the in-patient flow in a tertiary cancer center in Chennai, India from January 2020 to March 2021.…”

The “collateral damage” of the war on COVID-19: impact of the pandemic on the care of epithelial ovarian cancer

“…Most of these women present in advanced stages and require multi-modal cancer therapy, which extends over months involving surgery and chemotherapy [ 1 ]. It has been recognized that the coronavirus disease 2019 (COVID-19) pandemic has disrupted cancer care delivery [ 2 ], [ 3 ]. The impact has been due to two reasons: there has been a partial or complete shutdown of non-covid services in hospitals due to the overwhelming load of patients with COVID-19 illness and the “lockdown,” which was essential to control the spread of infection in society, affecting the movement of patients to the hospital [ 4 ].…”

Is Robotics the real game changer for Urological cancer care during COVID-19 crisis?

“…Ranganathan et al in their recently published cohort study in Lancet Oncology involving 41 hospitals in India have reported that, during the first wave last year about 70% of cancer patients in India were unable to undergo life saving surgeries and treatment and only 1/5th of the cancer surgeries was performed in March-May,2020 as compared to the same time frame in 2019. About 51,100 cancer surgeries were cancelled in India during the same time period [ 3 ]. It led to the cessation of cancer screening programs and increase in cancer stage migration, which will have a significant bearing in the cancer outcome in these patients in the future.…”