Patterns of Care of Gallbladder Cancer During the COVID-19 Pandemic: An Experience of Tertiary Care Centre at Patna, India

Abstract

Introduction: The novel coronavirus disease 2019 (COVID-19), is caused by the severe acute respiratory syndrome cronavirus 2 (SARS-CoV2). The management of cancer patients is very challenging during the COVID-19 pandemic. Cancer itself as well as anticancer treatment leads to compromised immunity of patients with increased risk of infection. This is turn leads to increased hospital visits. It forms a vicious cycle that increases the risk of COVID-19 susceptibility to cancer patients. Patients on anticancer treatment alongwith COVID-19 infection have higher risk of morbidity and mortality. Aim: To compare the epidemiological characteristics and management decisions in gallbladder cancer patients during COVID-19 pandemic. Methods: This retrospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna. Patients were divided into two group pre-COVID (patients attending radiotherapy department from December 2019 to February 2020) and established-COVID group patients (patients attending radiotherapy department from March 2020 to May 2020) with histopathological confirmed diagnosis of gallbladder cancer. Results: Histopathological confirmed cases of gallbladder cancer (n=85) were analyzed, 56 patients from pre-COVID timeline and 29 patients from established-COVID timeline were selected. During the pre-COVID timeline, 55.4% of the patients directly visited the radiotherapy department while, 24.1% patients directly attended the radiotherapy department during the established-COVID time. This reduction of number of patients at radiotherapy department was statistically significant (p = 0.006). There was statistically significant reduction (p = 0.014) in number of patients attending from rural areas during established-COVID time. Chemotherapy regimen used during pre-COVID and establishedCOVID timeline was significantly (p < 0.001) different. Conclusion: Cancer patient management during COVID-19 pandemic is an important issue. Chemotherapy increases the risk of COVID-19 infection by reducing the immunity. Single agent oral capecitabine is a good option for patients of gallbladder cancer in the adjuvant or palliative settings with less toxicity and requiring less hospital visits compared to intravenous chemotherapy.

Impact of COVID Pandemic on Cancer Care: Cross-sectional Scenario of an Indian State (Bihar)

“…The massive impact of lock-down on the public transportation and overall socio-economic disruption lead to such a significant drop of the visits of the cancer patients. Unfortunately, a striking number of patients who need palliative and supportive care would lose their lives without proper intervention in this pandemic [14]. Many centres including us are continuing the systemic chemotherapies with curative intent during the pandemic.…”