COVID-19: Experts say risks of postponing surgery, chemotherapy should be evaluated

With COVID-19 mortality rates higher among cancer patients in Italy and China, experts have suggested revisiting the goals of treatment, expected gains and combating complications of COVID-19 in an immune-compromised cancer patient. Oncologists and their patients need to debate the hard decision of a small reduction in the risk of recurrence over the next 5 years versus the higher risk of morbidity and mortality from COVID-19 in the short and medium-term, the experts believe. According to doctors at Medanta Cancer Institute in Gurugram , China and Italy have reported higher deaths among cancer patients. While China has reported a death rate of 7.6 pc among cancer patients, 20 per cent of patients who have died in Italy were also cancer patients. Padmashree awardee oncologist Dr Ashok Vaid, suggests that all activities that "we feel are unnecessary" should ideally be delayed but oncologist's advice should be sought on what is unnecessary and what is not. "In cases where the first cancer treatment has failed, patients should delay the second and the third line treatments or go to the facilities closer to their homes and avoid long-distance travels. A discussion with the oncologist is required about the quantum of benefit a particular intervention is likely to accrue," said Vaid.

"Many of the oncology treatments we currently use, especially those given after surgery to reduce the risk of recurrence have relatively small benefits, for example, certain subgroups of breast and colon cancer. However, many cancers are highly curable with modern oncology multimodal treatments. Therefore, withholding treatments for diseases like leukaemia and lymphoma may be detrimental," he added. According to Dr Sabhyata Gupta, the risks postponing any surgery or chemotherapy should be evaluated.

"There is some guidance from the Centre for Disease Control (CDC), USA, that 'elective surgeries' may be rescheduled, if possible. The American College of Surgeons (ACS) has also issued guidance for triage of patients for surgery relevant to cancer care. However, a lot of cancer surgeries cannot be considered elective. "Oncologists and patients will have to take a decision regarding postponement of surgery and explore the possibility of chemotherapy to shrink the tumour if the option exists. "Again, the latter approach will require hospital visits and the ensuing treatment related low immunity, and the risks thereof, must also be considered," she added.

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