Impact of COVID-19 on Outcomes for Patients With Cervical Cancer in India

Abstract

PURPOSE The COVID-19 pandemic has placed unprecedented demands on the health system. This led to delays in the initiation and completion of cancer treatment. We assessed the long-term health consequences because of the delay in diagnosis and treatment for cervical cancer due to COVID-19 in India. METHODS We used a Markov-model–based analysis assessing the lifetime health outcomes of the cohort of women population at risk from cervical cancer in India. The decrease in survival for those with the treatment interruption was calculated based on the number of days the treatment was extended beyond the standard duration. Furthermore, to model the impact of late diagnosis and delayed treatment initiation, the patients were assumed to have upstaged during the delay period, as per natural progression of disease. RESULTS We estimate 2.52% (n = 795) to 3.80% (n = 2,160) lifetime increase in the deaths caused by cervical cancer with treatment restrictions ranging from 9 weeks to 6 months, respectively, as compared to no delay. On the contrary, 88-238 deaths because of COVID-19 disease are estimated to be saved during this restriction period among the patients with cervical cancer. Overall, the excess mortality because of cervical cancer led to 18,159-53,626 life-years being lost and an increase of 16,808-50,035 disability-adjusted life-years. CONCLUSION Delays in diagnosis and treatment are likely to lead to more cervical cancer deaths as compared to COVID-19 mortality averted among the patients with cervical cancer. Health systems must reorganize in terms of priority setting for provision of care, starting with prioritizing the treatment of patients with early-stage cervical cancer, increasing use of teleconsultation, and strengthening the role of primary care physicians in provision of cancer care.

Impacto do COVID-19 morbimortalidade de pacientes oncológicos em Teresina-PI

“…Embora haja redução na taxa de mortalidade e de internações nos pacientes oncológicos, quando comparamos as taxas de mortalidade mostradas nos Gráficos 1 e 2, segundo Blay et al 2021 isso não implica em melhora da assistência ao paciente com câncer, pois dentre os vários fatores envolvidos para diminuição está a diminuição na procura por assistência médica e medicamentosa, realojamento da atenção das unidades de saúde para atenção à pandemia do covid-19 e adoecimento dos profissionais de saúde, contribuindo para um atraso diagnostico e terapêutico de pacientes com câncer. Além disso, esse fato é observado em varias cidades em todo o mundo, percebendo que, com o surto de COVID-19, muitos pacientes por temerem essa doença deixaram de ser acompanhados adequadamente, tendo um impacto negativo no tratamento do câncer no período pandêmico (Saini et al 2020) Porém, segundo Gupta et al (2021) percebe-se uma alta letalidade do vírus quando associado ao câncer, chegando há 51%, quando comparamos o Gráfico 5 com o Gráfico 4, pois como se sabe o câncer é uma comorbidades que pode afetar o sistema imunológico, fazendo com que pacientes com câncer sejam mais suscetíveis a infecções, seja pelo efeito imunossupressor da quimioterapia e/ou pelo comprometimento da capacidade pulmonar Além disso, durante o período pandêmico de 2020-2021, houve adiamento de cirurgias para remoção de tumores e atraso no tratamento quimio ou radioterápico que momentaneamente levou diminuição de internações (Degeling et al 2021) como pode-se observar nos dados apresentados pelo Gráfico 1.…”

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

“…Moreover, one-third of the patients undergoing curative-intent treatment had compromised care even in their report. According to a recent Markov model-based estimate of lifetime health outcomes among women with cervical cancer in India, mortality will increase from 2.52 percent to 3.80 percent due to pandemic [ 11 ]. Similarly, inevitably, compromised care delivered to patients with EOC during the pandemic will adversely affect their outcomes.…”

Efficacy of Influenza Like Illness (ILI) Screening OPD for COVID-19 at a High-Volume Centre: Unlocking Routine OPD

“…The problem of the lack of healthcare services during the pandemic has had its impact over many chronic diseases, be it ophthalmological, orthopaedic, dental services most of which have suggested a screening system for patients and better protective gear for healthcare providers (11)(12)(13) This exercise which we conducted at the premier Institute of India was to ensure the safety of the medical healthcare workers and the patients, though the results were not encouraging in terms of the positivity rate, but it was a great learning experience for us.…”

“…This pandemic has shown an unpredictable pattern as far the peaks and troughs are concerned, since the predicted models were inaccurate and the forecasts had failed, especially so, during the initial stages (9).The pandemic has had a debilitating effect on health status of patients with chronic illnesses who found it di cult to access healthcare services amidst the pandemic (10). Both the mortality and morbidity of chronic non-COVID disease increased during the initial lockdown (11). Thus, it is only prudent to continue the OPD services and add screening layers depending on the current position of the pandemic.…”