Unlike other medical disorders such as stone diseases, cancer treatment is time-sensitive. The later a patient sees a doctor, the more advanced their cancer is, necessitating more complicated therapy. At the end of the day, cancer is a’referred disease.’ A general physician or specialist is usually the one who suspects the development of cancer, which is subsequently explored by a cancer super-specialist after a referral to a better medical facility.
During the coronavirus disease (Covid-19) pandemic, cancer detection went up for a toss in many areas where new patients could not be taken in for treatment because most of these physicians were either not available or tied up with Covid-19 treatment.
At the height of the Covid-19 second wave in April-May 2021 and later during the third wave in January this year, registration of new cancer patients has plummeted across the country. However, following the second wave of the pandemic, new registrations of cancer patients jumped once again in June last year as both primary care physicians and patients were willing to step up for non-Covid treatments.
Ahead of World Cancer Day on February 4 (Friday), Dr. Shubham Garg, senior consultant of surgical oncology at the Fortis Hospital in Noida, shared a few insights on the significant trends reported in cancer treatments:
Treatment Interruptions: Cancer treatment is long-drawn. Surgery requires admission for seven to ten days, while radiotherapy requires daily visits to the hospital. Chemotherapy, too, requires periodic visits to the hospital.
Due to Covid-19, especially in April- May 2021, hospital services were badly hit and patients were not able to go visit the hospitals. This led to an interruption in treatment that influenced its effectiveness. According to Dr. Garg, there were also times when even the patients could not go to the hospitals due to other pressing family issues.
This led to a drop in chemotherapy cycles during the second wave of the Covid-19 pandemic.
However, what was observed during Phase-3 of the Covid-19 pandemic, says Dr. Garg, was “incidental positivity” – asymptomatic patients were subjected to a Covid-19 test before every admission, which not only added to a procedural hurdle in seeking treatment, but also led to many patients being detected with Covid-19 and unwanted treatment stoppage.
Higher risk in cancer patients: It is a well-documented fact that Covid-19 deaths were reported more among elderly patients with comorbidities and the immunocompromised.
“Cancer patients actually fit in the perfect template for a ‘high-risk patient’ in terms of Covid”, said the senior doctor.
UP trends for cancer: Tobacco has been the bane for cancer patients in Uttar Pradesh, particularly those from the western and eastern parts.
“Initially, we used to get patients with advanced diseases from the interiors of Uttar Pradesh, but now what we get are partially-treated patients or poorly-treated patients from these Tier-2 cities,” said Dr. Garg. “This is due to the fact that in the last couple of years a lot of cancer treatment facilities have mushroomed in UP’s tier-2 cities, such as Meerut, Bareilly, Kanpur, Gorakhpur, and the likes. These centers are bound by the limitations of technology or skillset and sometimes end up providing sub-optimal treatment, leading to incomplete treatment or early recurrence. Treating such patients is a different challenge altogether.”
Technological advances: As most cancer patients are diagnosed with the disease in the head and neck region, Dr. Garg said that top hospitals like Fortis offer specialised oncoplastic services allowing for “better reconstruction”, following cancer surgery in the head and neck. It also allows for better functional and cosmetic recovery, he said, specifying that advanced medical techniques like microvascular surgery also allows for free flap transfer.
HIPEC surgery: Despite proper chemotherapy, many patients may have residual diseases. However, these can now be tackled surgically, wherein during surgery only chemotherapy can be instilled at high temperatures so that the resistant disease can be removed. This is a specialised surgery technique and requires advanced machinery where chemotherapy is heated and administered at a constant temperature.
SBRT: Stereotactic body radiation therapy (SBRT) allows precise targeting of radiation so that side effects to surrounding structures can be minimised.
Immunotherapy: This type of therapy activates one’s immune system to fight against cancer cells allowing minimal side effects and better effectiveness.