COVID-19 forces cancer patients to arrive for treatment at advanced stage

A shooting pain in the joints rarely ever raises an alarm especially in an arthritis patient for whom experiencing inflammation stiffness and muscle weakness is routine So when the 78yearold mother of a Goabased writer started complaining of joint aches in the thick of the Coronavirus lockdown last year it made sense to wait it out ldquoWe miscalculatedhellip I think we all didrdquo he now admitsA year ago at this time Goa had a strict lockdown in place ldquoThere was huge paranoia then we were mostly ignorant about how the virus travelledrdquo recalls the writer who requested anonymity The advice very plainly put was to not visit doctors at hospitals because there was a high risk of contracting COVID19 within the premises He tackled the joints pain with more physiotherapy and painkillersWinston Fernandes centre was diagnosed with Stage IV Hodgkinrsquos Lymphoma during the 2020 lockdown He suffered from erratic coughing bouts all through April and May His brother Vinifred left says that had it not been for pandemic restrictions the family would have immediately consulted a doctorEarlier this year after her condition worsened the family rushed the septuagenarian to a hospital ldquoTo our shock we discovered that she had a severely metastasised colon cancer which had spread into the bones This not just makes it painful and difficult for my mum to move but given her age provides no chance of cure The doctor said she has months rather than years She is largely bedridden now and mainly doing physiotherapy But she is stuck in a gruelling grind of chemotherapy which at the end of it promises no recoveryrdquo In hindsight he feels his mental block towards hospitals during the lockdown was unwarranted ldquoI definitely regret not doing something about it earlierrdquoAccording to a report in Cancerworldnet the number of patients registered at the cityrsquos Tata Memorial Hospital dropped by more than 25 per cent from 82500 in 2019 to less than 60700 in 2020 The resultant delay in timely diagnosis has led to more advanced incurable cases of cancer emerging making treatment a huge task for oncologists ldquoThis year At least 2530 per cent of my patients came in at an advanced stage I have had to politely tell them lsquoSorry we cannot do anything morersquo Some of these cases are inoperable or not salvageable Itrsquos been that extremerdquo said Dr Deepak Parikh director Asian Cancer Institute Cumballa Hill Hospital ldquoAmong them at least 70 per cent cases were of people who had been feeling something wrong for nearly a year but held back due to the pandemicrdquo Jaipur resident Vishnu Duttarsquos father Durgarsquos surgery was delayed by nearly a year due to the pandemic He was to be operated on in March 2020 and when they returned for surgery in September he tested positive for COVID19 A rather mutilating surgery had to be performed in January 2021 which his doctor says couldrsquove been avoidedThe challenge is not a new one for India The obstacle posed by COVID19 aside Indiarsquos cancer mortality rate has always been high primarily because most cases are detected in advanced stages A 2015 paper by Shripad D Banavali in the Indian Journal of Medical and Paediatric Ocology revealed that 68 per cent patients with cancer die of the disease in India as compared with 33 per cent in the US The pandemic if anything has made the crisis worseFor Mira Road resident Winston Fernandes 22 the pandemic proved to be a major hurdle not just with diagnosis but prognosis too Winstonrsquos elder brother Vinifred Fernandes 27 says that a month after the lockdown was imposed in March 2020 Winston began developing mild fever ldquoIt would keep coming and goingrdquo he says ldquoHe also started coughing incessantly But apart from that there were no real symptomsrdquo Had it not been for COVID19 he says his mum wouldnrsquot have relied on overthecounter cough medicines for two months ldquoWhen that didnrsquot seem to help we spoke to a chest specialist who suggested that we get an Xray It revealed a small mass in the chestrdquo says Vinifred After running a few tests including a CT Scan biopsy and PET Scan Winston was diagnosed with Stage IV Hodgkinrsquos LymphomaJaipur resident Vishnu Duttarsquos father DurgaThe family immediately began with the chemotherapy cycle and his body was responding well to it but right before the second round of therapy he was diagnosed with COVID19 The family was eventually advised to get a Haematopoietic Cell Transplant a type of bone marrow surgery which would give Winston a fighting chance to survive The doctors successfully performed the transplant and Winston was discharged earlier this monthVishnu Duttarsquos 73yearold father Durga Duttarsquos surgery was also delayed by nearly a year Durga who lives in Jaipur has been battling oral cancer for over a decade He was being treated by Dr Parikh in Mumbai when the lockdown was announced ldquoFive years ago my father had a major surgery known otherwise as a commando procedure on the left side of the mouth He underwent a similar procedure on the other side the following year in 2017rdquo says Vishnu who works in the finance sector ldquoLast year two days before the lockdown we came for a followup and at the time Dr Parikh had suggested a third surgery But with news about the impeding lockdown we thought it would be safer to return later We have no family in Mumbairdquo he adds in a telephonic chat It wasnrsquot until August that they could fly down and surgery was fixed for September Unfortunately his father contracted COVID19 and was in the ICU for nearly 20 days ldquoAround 80 per cent of his lungs were damaged When nothing seemed to work he was given Remdesivirrdquo his son saysThe number of patients at Tata Memorial Hospital dropped by more than 25 per centmdashfrom 82500 in 2019 to 60700 in 2020 Since many of the patients at the hospital come from rural parts of the country access to transport and stay has been an issue during the lockdown Several also chose to get operated at hospitals closer to their homes PicSuresh KarkeraDurga was discharged after an excruciating one month Due to the extreme toll COVID19 had taken on his health no surgery happened that year He finally returned in January this year ldquoBut the tumour had grown considerably by then and hence we had to do a more mutilating surgeryrdquo says Dr Parikh Vishnu 41 who lost his mother in his teens says this experience has been his toughest yet His father has started showing symptoms again ldquoWe want to do followup butbecause of the current lockdown in Mumbai it seems next to impossiblerdquo Vishnu believes that it is his fatherrsquos will power alone that has helped see him through thelast one yearWith cancer time is not just crucial it is also a gamechanger When you broadly look at cancers Stage I offers a 90 per cent survival chance while Stage II 75 per cent Dr Parikh says ldquoThe moment it goes to Stage III and IV the percentage drops down to 40 and 20 per cent respectively It means you have just a 50 per cent chance of survival Thatrsquos a quantum loss we are going to face and the numbers of cancer fatalities are most likely to show up by the next year or sordquo Viji Venkatesh region head India and South Asia at The Max Foundation which organises the annual Chai for Cancer to raise funds for cancer survivors says their collection dropped by 40 per cent last year They had to dip into the previous yearrsquos funds to support cancer patientsDr Boman Dhabhar consultant oncologist at Masina Hospital speaks of a 75yearold who recently came to him for a consultation ldquoThe patient first started experiencing postmenopausal bleeding in March last year Her doctor had suggested DNC dilation and curettage a procedure to remove tissue from inside the uterus but she couldnrsquot make up her mind Then the lockdown happened and the wait became indefinite She panicked when she started bleeding heavilyrdquo Following a PET scan she was diagnosed with endometrial cancer The patient he says had to eventually undergo radiation which was something she could have skipped had she taken timely treatment ldquoFortunately for her the cancer did not spread but the nature of the disease is such that it grows and quickly You cannot wait with blood cancer for instance It can get very aggressive A month here and there and everything is lostrdquo says Dr DhabharWhat adds to the complexity is that its symptoms are subtle In cases of breast cancer a cancerous lump often doesnrsquot hurt and therersquos no fever so people generally neglect it A study by a regional healthcare centre in Kolkata has revealed that the average time for breast cancer diagnosis in a patient in India is roughly about four months A paper published in the South Asian Journal of Cancer in 2019 pointed out that a diagnostic delay of anywhere between three and six months for breast cancer can lead to ldquopoorer survivalrdquo ldquoItrsquos not for nothing that they say that the best time to treat cancer is lsquoyesterdayrsquordquo says Dr Anil Heroor HeadSurgical Oncology Fortis Hospital Mulund and Hiranandani Hospital Vashi ldquoBut cancer doesnrsquot wait for COVID19 It wonrsquot stop for the pandemic to endrdquo says Professir Shailesh V Shrikhande deputy director Tata Memorial Hospital Head of Cancer Surgery Tata Memorial Centre MumbaiDr Deepak Parikh director Asian Cancer Institute Cumballa Hill Hospital says that while most doctors made themselves available for video consultations it can never replace a physical examination which is crucial when treating cancer PicAtul KamblePuneet Sachdeva is CEOfounder of AaM Press a popular online news and views platform aimed at empowering the middle class Diagnosed with what one of his doctors described as the ldquofriendliest of blood cancersrdquo in September 2018 Sachdeva 46 a resident of Madh Island was on heavy medication for nearly a year After his condition got critical in 2019 during a work trip to Chandigarh where his parents live he decided to continue taking treatment at a government hospital there ldquoI had to constantly monitor my cancer factor which is measured by a genetic test called BCRABL that helps diagnose CML a type of leukemia If my BCRABL report was below 1 it meant I was in the safe zone When I was first diagnosed it was 50 By the end 2019 it was somewhere around 7 This meant that the treatment was working So I went back to Mumbai and returned to Chandigarh for a checkup on March 9 2020rdquo Thatrsquos when the doctor shared the good news with Sachdevamdashhis BCRABL was 04 He was almost cancer free ldquoFor a cancer patient itrsquos like getting a new lease of life It felt like a huge load was off my shouldersrdquo Back in Mumbai just before the lockdown Sachdeva spent the next few homebound months creating online content for his social media platform A followup was due in July but because he was already immunocompromised he was wary of taking a flight By September his BCRABL also shot up to 13 ldquoMeanwhile I launched an online stock market programme started taking care of my health and slept longer hours This did help my BCRABL dropped to 8 by NovemberrdquoProf Shailesh V Shrikhande Dr Anil Heroor Dr Boman Dhabhar and Anita PeterAs Mumbai started opening up in December Sachdeva says he considered going to Chandigarh one time too many ldquoBut I am paranoid I canrsquot afford to get COVID19rdquo he says Only recently he arranged for a driver to take him home ldquoAnd just then the second wave hit us Now I have no idea when I can leaverdquoAccording to Dr Heroor the logistical issues posed by the pandemic have only compounded the problem ldquoWhile a lot of urban educated Indians were generally fearful about the virus the difficulty in travelling and lack of public transport in the lockdown meant they were venturing out lesserrdquo Cancer patients in the rural parts of the country were worse hit ldquoI had a patient who knew she had a lump in the breast but the family was finding it difficult to bring her from their village In no time her lump which was the size of a lemon spread to the entire breast Her cancer had become advancedrdquo he saysAt Tata Memorial Hospital in Dadar East the objective was clear at the onset of the pandemicmdashcancer is an emergency and no surgeries can be delayed The team even published a firstofitskind paper in June 2020 sharing the outcomes of elective cancer surgery conducted between March 23 and April 30 2020 They had conducted 423 surgeries during that timemdash371 without a COVID test and 84 per cent surgically complex procedures There were no deaths ldquoIn 2019 we did about 8641 major operations in the department of surgery These operations went down to 6002 in 2020 This means we did around 2400 less surgeriesrdquo says Dr Shrikhande the hospitalrsquos deputy director while dipping into hospital records ldquoBut this is still a big number because Tata is one of the few hospitals that chose to continue operating as a cancer hospital rather than getting converted into a COVID hospitalrdquo he saysMost private hospitals didnrsquot have this choice The situation has only worsened with the second wave Dr Parikh says that a lot of their hospital resources were dedicated to COVID19 patients ldquoMost cancer patients postoperation require ICU care for the first 48 to 72 hours at least So there were instances where we had to check for bed availability before taking them in for surgeryrdquo he says adding ldquoRight now too itrsquos likely that minimal resources will be dedicated to nonCOVID19 patients so we are likely to be staring at another crisis if things donrsquot get betterrdquoIn a move that however came as a relief to many oncologists at both public and private hospitals made themselves available for online video consultations Dr Parikh says that this however isnrsquot the best option when you have to examine the operated area or the tumour ldquoPhysical checkup cannot be replaced by an online one but we were trying to be there for them patients as much as possiblerdquo he saysThe financial burden on caregivers and families of cancer patients has only exacerbated in the pandemicViji Venkatesh region head India and South Asia at The Max Foundation which organises the annual Chai for Cancer to raise funds to support cancer survivors says that even before the pandemic it took a lot of effort on the familyrsquos part to bring the patient to the hospital ldquoThere is discrimination depending upon the age and the gender of the patient If the patient is a senior or a woman families consider how expendable they are or not before deciding whether to go ahead with the treatmentrdquo she shares ldquoWith the pandemic all these constraints multiplied to unimaginable limits making it difficult for patients to access good treatmentrdquo Last year Chai for Cancer was held virtually on the second Sunday of May and though Venkatesh got the patients and doctors to hold lsquoaddasrsquo to create awareness their collection dropped by 40 per cent ldquoBecause we had backup funds from the previous years we didnrsquot stop any of our work But I am determined to raise as much as possible this yearrdquoAnita Peter executive director Cancer Patients Aid Association faced another kind of problem too ldquoWe used to have a cancer insurance policy for those registered with us But many of them submitted their claims so late due to the lockdown that it became tough for us to do anything The rule is that you have to submit the policy within three months of the treatmentrdquo In January the NGO had to pull a plug on their cancer policy ldquoItrsquos one of the many activities that had to close down because we didnrsquot get enough donationsrdquo They had to direct their limited funds for other important cancer initiativesVenkatesh says that despite the impossible hurdles medical practitioners have done their best ldquoYes it hasnrsquot been easy for patients But doctors and hospitals have gone out on a limb to be there for them They have changed their administrative capabilities and SOPs and made themselves available 24x7 on phone so that people suffer lessrdquo2400Dip in number of surgeries from 2019 to 2020 at Tata Memorial HospitalHow to avert advanced cancer People need to make conscious lifestyle changes especially when it comes to chewing tobacco and smoking because they contribute significantly to some of the cancers today If you do show any kind of symptomsmdashlike a swelling or ulcerationmdashconsult a doctor if it doesnrsquot settle within a week or two When you sense something amiss donrsquot be in denial Do not bury your head like an ostrich in the sand and tell yourself that you cannot get the disease Once diagnosed never skip a followup Like COVID19 cancer also has doubling time so you canrsquot afford to wait before it gets worseDr Deepak Parikh director Asian Cancer Institute Cumballa Hill Hospital