Cancer in the Covid era

COVID – 19 has brought the entire world to its knees, mobilizing reserves and resources of every nation towards its fight. Since the virus is new, one needs to unravel its mysteries to understand its sinister course and the extent of havoc it may create. One thing is certain that viruses which come from animals to humans do not leave mankind before 100 years. A vaccine may ease the situation to some extent but learning to live with the virus as we have done with other will help stabilize the situation faster. Many of us will sail through, but the vulnerable groups will have to pay a heavy price for this crisis.

Developing nations like India, have cancer as the third most common killer. According to the National Cancer Registry, 1 in every 8 Indian will have cancer in his or her lifetime.

How are we going to look at Cancer in the COVID era?

Cancer patients are at a two-fold higher risk of contracting COVID – 19 and a 5-fold higher risk of developing severe form of the disease. Most are immunocompromised either because of the disease per se or become so with the treatment – chemotherapy / radiotherapy. Hypoproteinemia and anaemia commonly seen in these patients further compromise the immune system. Also, half of all of cancers in men and a quarter of cancers in women are tobacco related and tobacco per se weakens the immune system. Most solid cancers occur in a higher age group who also have associated co-morbidities – hypertension and diabetes, etc. thereby making them even more vulnerable.

Would cancer patients have symptoms different from others?

Symptoms of COVID – 19 disease seen here are same except the severity of the symptoms are higher. Pneumonia, ARDS , Sepsis , Shock , Cardiac injuries, multi-organ failure can be seen . Rapid deterioration is quite common .

Do cancers of different sites have different susceptibility to the virus?

Yes they do. Scientifically the virus has a strong affinity to the ACE-2 receptors in the different organs: Lungs, heart, kidney, bladder, oesophagus, small intestine, colon, liver, gall bladder, muscles and testes. So cancers with high ACE–2 expression viz. Colo-rectal, Renal Carcinomas, Pancreas, Stomach and Lung are all susceptible to COVID infection.

Does tumour stage influence susceptibility?

Since the virus is new, to comment on the influence of the stage of the cancer on vulnerability may be a bit too early. Hypothetically, the more advanced the disease higher should be an individual’s susceptibility.

Would cancer treatment change in the COVID era?

One will have to assess the potential benefit of any oncological procedure over cancer recurrence / overall survival vis-a-vis the potential risk of death from COVID-19 . Elective surgeries on a COVID positive patient should be put on hold till there are two negative COVID tests spread over a span of 24 hours. Only emergency surgeries when warranted may be performed on the positive patients. Surgeries performed on patients on COVID positive patients, have a 28 – 32% risk of life – threatening complications and a 28%mortality.

But the operative risks do weigh heavily on the surgeon if the patient is COVID positive. The surgeon not only runs the risk of contracting the infection, but also may develop severe complications due to inhaled viral load from the aerosol generated during the procedure. So to minimize this ill impact long duration complicated surgeries may have to be replaced with shorter and simpler procedures without compromising on the disease clearance. This may result in increased morbidity and yield lesser cosmetic results.

Would lockdown cause a surge in the cancer cases?

Due to lockdowns and travel restrains cancer patients would have great difficulty in accessing health care facilities. So lack of timely access and also the fear of contracting the infection will lead to surge of advanced cases at the various centres.

Will the cost of treatment escalate?

The cost of cancer treatment has escalated. Investigations pertaining to COVID -19 virus coupled with greater use of consumables (masks, PPEs, eye shields etc.) and the use of special equipments would all add to the cost factor.

What should a cancer patient do to protect oneself?

All cancer patients should restrict their outdoor movements. Regular hand hygiene, the constant and correct use of face mask, social and physical distancing will remain as main pillars for prevention of Covid19 infection.

A pertinent question which remains to be answered. Is the phobia to this virus a bit too much or can it be assuaged as we learn further? We are just beginning to unravel the mystery behind biological behaviour of this virus. Answers may not be far off. Till then it is important to play safe and stay healthy