COVID-19: 'Make tough decisions to run cancer care'

Make difficult decisions to run cancer care in the days of coronavirus: Tata Memorial Centre doctors

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Amidst reports of hospitals closing its doors on non-coronavirus patients, India’s topmost cancer hospital has shown to the world how it’s possible to run the regular services if doctors and hospital administrations make some tough and timely decisions.

One of the difficult decisions that doctors at Tata Memorial Centre, Mumbai had to make was prioritising the patients requiring cancer therapy.

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“Patients with the potentially curable disease who could substantially benefit from treatment are given high priority, whereas care for patients who were being treated with palliative intent, especially those for whom interventions are expected to have marginal benefit, is being deferred,” they wrote in a note published in the New England Journal of Medicine.

In other words, they have to choose between a patient, who has greater chances of survival over someone who is being treated to relieve pain without addressing the root cause.

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“Decisions are made by balancing the risk that patients will contract COVID-19 because of exposures associated with cancer treatment—and their risk for complications if they do — with the benefits of receiving potentially lifesaving cancer treatment,” TMC oncologists C S Pramesh and Rajendra Badwe wrote.

The doctors admitted that they had to make “some difficult choices”. But on the plus side, it was possible to run regular services at the TMC albeit on a lower scale because of the social distancing measures.

Publication of the TMC experience coincided with the Union Health Secretary Preeti Sudan’s letter to the states asking them to convince private hospitals to re-open so that patients are not denied treatments like blood transfusion, dialysis, chemotherapy and institutional delivery.

“For a center that sees more than 70,000 new patients with cancer each year, even a slowdown in clinical services is likely to have a substantial impact on outcomes. Although cancer is often not immediately life-threatening, treatment services are also not entirely elective, and delaying care can have serious adverse consequences,” they wrote.

Early action on COVID-19 patient screening, contact tracing and social distancing, and not a huge number of patients overwhelming Mumbai hospitals are factors that TMC took into account while deciding on the course of action.

The hospital also established a staff-sparing strategy, which involved providing paid leave for at-risk employees and rotating remaining staff. “The countries that have not had high rates of death from COVID-19 could consider similar approaches to balance pandemic control with the provision of continued cancer care,” the TMC duo observed.