Providing care for patients with cancer during this crisis is arduous, given the battling risks of death from cancer versus death or serious complications from SARS-CoV-2, and the likely higher lethality of COVID-19 in immunocompromised hosts.
Finding a fine balance, weighing the risks and benefits for each patient and customising care is needed like never before. Relying on observational data and the experience of countries ahead of us in timeline and numbers, there are no blanket or one-stop guidelines given how fluid and dynamic the situation is. The general principle is to balance the risk of cancer progression against the risk of Covid-19 infection while assessing the potential benefits of treatment by various modalities like surgery, chemotherapy and radiation therapy. Many patients with cancer are tussling to receive treatment for their cancers as hospital care is diverted for tackling the emerging pandemic.
Salient points one need to check while finding this special balance in these testing times:
Newly diagnosed gynaecologic cancer patients during the pandemic
Deciding whom to treat, for patients who are newly diagnosed/ need work-up for evaluation of cancer needs to emphasised and a policy of including all is necessary to prevent undue harm from cancer progression
- Include every patient to begin cancer treatment if the potential oncological benefit is clinically significant ‒ if it is potentially curative, or effective against metastatic disease, or even if there is an immediate need for palliating symptomatic disease.
- However, the decision must be personalised, in discussion with each patient, according to the risk‒benefit factors of the patient and their disease.
- There are no guidelines, and decisions are made on the basis of basic principles, ethics and common sense, with thorough discussions involving all multidisciplinary team members, taking inputs from patients and their caregiver in an open transparent way is the essence of treatment in times of pandemic.
Existing gynaecologic cancer patients during the pandemic
- As a general rule, and where adequate precautions are in place, it is important to continue cancer treatment rather than delay for fear of infection. Such clarity comes from institutes with published guidelines. There isn’t evidence to stop or change a line of management a patient is already receiving, while we counteract the risks of infection.
- Use our own clinical judgement and personalising care. Consider the prognosis of the patient and weigh the chances the therapy will really help them and tailor needs accordingly
- As usual, all decisions should be reached in full and open discussion with the patient by gathering as much information from the patient and their care-givers to fully understand their apprehensions on both sides.
- For our patients on follow-up, reassuring over teleconsults, managing symptoms, if any and protecting their general well being is more important now than ever.
- This is an especially stressful time for our patients and we need to help them manage stress, anxiety by honest discussions in an empathetic way. The need for multiple discussions while they decide cannot be overemphasised, preferably as teleconsults as we limit hospital visits.
- Having virtual support group meetings addressing common issues faced by women with gynaecologic cancers. Also gives strength, bonding and a sense of feeling that they are not alone in this time of crisis.
While we have the ‘new normal’ ways of interacting and connecting, we hope to keep this transition smooth and seamless to ensure utmost physical and mental well being of our patients and their care-givers too.
Author is a Consultant, Gynaecologic Oncologist at Max Institute of Cancer Care, Max Hospital , Saket