Caught between cancer & Covid-19

The World Health Organisation recognises that cancer is a leading cause of death globally, accounting for 10 million deaths in 2020. In a report, the WHO further suggests 70% of these deaths occur in low and middle-income countries. Tobacco use, obesity, alcohol use, low fruit and vegetable intake and a sedentary lifestyle have been identified as the key risk factors driving the high burden, accounting for about 33% of all deaths due to cancer. Infections such as hepatitis and human papillomavirus (HPV) are also important causes of cancer in developing countries. A report published by the National Cancer Registry Programme Report 2020, suggests that cancer affected about 13.9 lakh people in India in 2020, the most common sites being breast, lung, mouth, cervix, uteri and tongue. This number is expected to rise by 12% to about 15.6 lakh by 2025.

Burden in young adults

Although the risk of cancer increases with progressing age, certain cancers such as colorectal cancer and breast cancer have become increasingly common among young adults in the age group of 18 and 49 years of age during the last 10 years, accounting for about 10.2% of the total cancer cases reported globally. In India, the prevalence of cancer in young adults has been reported to account for about 6.26%-26.6% of total cancer cases in different studies. One study also suggests a steady rise in the number of cases from 1997 to 2006 in this population and females to be at two times higher risk as compared to their male counterparts. When compared to cancer in older patients, cancer in younger patients is associated with significantly higher loss in productive years and economic burden. It is also associated with a higher risk of long-term effects such as sexual dysfunction, infertility, future risk of cancers and heart problems. Cancer in this age group is also likely to experience a delay in diagnosis due to lack of awareness and failure to seek early care.

Impact of pandemic on cancer care

The fear of contracting Covid-19 infection, travel bans, financial crisis due to lost jobs and disruptions or delays in cancer services have resulted in a large gap in treatment among most cancer patients globally. For example, a study in the United Kingdom suggested a 20% increase in cancer-related deaths during the ongoing pandemic. Similarly, another report suggests a drop of about 50% in consultations of new cancer cases in India. In many cases, delayed or postponed surgeries resulted in tumours progressing to advanced stages, more aggressive treatment and many to a palliative stage where no cure is possible. This adversely affected survival and the patient’s quality of life. For example, early breast cancer is usually managed with breast conservation therapy, however, cancer that has metastasised would require aggressive chemotherapy in addition to mastectomy.

There has been a rapid increase in Stage 3 and Stage 4 breast, colon and head and neck cancer cases as compared to the pre-Covid-19 era. In most cases, failure to seek early medical care has led to cancers that have increased in size and spread to other parts of the body requiring more aggressive treatment. A delay in diagnosis and treatment not only reduces treatment options but also impacts the survival and quality of life of cancer patients. A failure to follow-up in cancer patients can delay diagnosis of recurrence and also assess treatment response.

Need for early care

In the early phase of the pandemic, many cancer surgeries and treatments were delayed owing to fear of increased susceptibility to the infection in cancer patients. Though short-term delays of about 1 or 2 months in initiating treatment do not have a major impact on outcomes, any delay more than that can impact survival and outcomes in such patients. In the light of the same, most international cancer guideline bodies recommended the use of telecommunication even in the early phase of the pandemic to seek professional advice from oncologists regarding treatment decisions in both Covid-19 infected and non-infected patients to understand the risks and benefits of treatment required in a particular case in
the given pandemic setting.

Mounting evidence suggests that about 30-50% of cancer risk can be cut down by controlling risk factors and through effective screening at an early stage. Many cancers have a high rate of a cure if diagnosed and treated early. For example, breast cancer diagnosed at the early stage has a five-year survival rate of greater than 90% as compared to metastatic breast cancer (28%). Similarly, localised prostate cancer has a five-year survival rate of about 100% as compared to 30% with metastatic prostate cancer. In the current pandemic situation, cancer patients should not lose any more time in seeking medical care to avoid further complications as most hospitals are following stringent protocols to provide safe consultation and treatment to cancer patients.

(The author is a Bengaluru-based consultant in medical oncology.)