Do not ignore cancer awareness in the present viral pandemic!

On March 11, 2020, WHO declared COVID-19 as a global pandemic that rapidly crossed borders and led to a major healthcare crisis and economic slowdown. The crisis has brought the world to a near-complete standstill. As of June 23, 2020, the pandemic has affected more than 90 lac people and caused nearly 5 lac deaths. Most international health organizations have stated an urgent need to stop, control and reduce the impact of the virus at every opportunity. 

It was a busy Wednesday morning clinic in the now new normal, the COVID times. N95 masks on, head caps in place, shoe covers mounted on the shoes while remembering to maintain social distance with my patients. My next patient, a 60-year-old lady, seemed a routine head and neck cancer patient. I quickly went through the records, followed by a clinical examination. The patient had locally advanced disease with a large mass in the tongue, going across midline with fixity to adjacent structures. The family seemed reasonably well off and well aware, so my next question was the reason for the delay in presentation. There was a tiny ulcer in a tongue in December last year, her elder son stated, immediately after which she developed a heart attack and remained hospitalized for a month. Just after this, when they have advised a biopsy, the nation was put under lockdown and they could not manage to get the biopsy done for the next 2 months. And here they were, with inoperable tongue lesions and extremely limited options for treatment. It seemed a clear case of progression of stage 1 cancer to stage 3, and the only reason was a delay in getting the biopsy done. 

This case illustrates the bitter present-day realities in oncology during the COVID times and the dilemmas faced by oncologists in inpatient care. Cancer is the second leading cause of death globally and as mentioned in research it is responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer. According to the study, approximately 70% of deaths from cancer occur in low- and middle-income countries. However, present-day newsprint, television, social media, government thrust, and health expenditure is overflowing with thrust on the risk of COVID and everything else (including dreaded cancer) has taken a backseat. Many patients are so fearful of COVID that it overtakes and overruns even the fear of cancer progression or disease recurrence.  While the global medical community is engaged in finding a vaccine or a drug for COVID, oncologists need to reemphasize and refocus on creating awareness and reinforcing the need for early care in cancer. In a similar vein, patients need to be told about the perils of delaying cancer treatment We may have spent decades in researching screening, molecular profiling, gene analysis, higher tesla MRI, robotic surgery devices and modern linear accelerators, but the present-day world situation has posed a new concern. Countering this challenge requires reinforcement of basic oncology principles to all our patients.

Two key messages are the need of the hour. One, everyone needs to get evaluated for potential symptoms of cancer early. And second, those with the established disease should avoid deferring critical therapeutic components of cancer care. These simple measures would go a long way in saving many lives all around the world. 

 

Dr. Anusheel Munshi

Head - Department of Radiation Oncology

Manipal Hospitals, Dwarka, New Delhi


 

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