A few years ago, on a stormy Monday morning in March, I was diagnosed conclusively to have cancer. Shock, denial, fear, and an irrational anger washed over my confused brain. At that moment, the most fierce emotion that gripped me was to have an immediate operation, right there and then. I wanted it out. I felt violated, polluted, and I could not wait to get the alien out of my body. I wanted my surgeon to act immediately, without wasting even a day, or a minute.
This basic fear is what must be terrorising our innumerable, as yet untreated, cancer patients today.
So, does cancer wait and pause in its tracks, whilst we defer treatment, for whatever reason? Will cancer wait idly, while a COVID virus takes centrestage, and takes over hospital resources, beds, and doctors, and drains all hopes of a cancer cure? Figuratively speaking, will not the cancer laugh in glee, and just storm into the defenceless victim’s psyche and body with impunity? Should we block all pathways of treatment for other serious diseases, and concentrate on just this one virus? And for how long can this state of affairs continue?
My thoughts dwell on issues like: What is happening to our cancer patients in this COVID age?
How were we coping with the cancer problem in the pre-COVID days? Can cancer patients be ignored because COVID dominates health care today?
Does a waiting period of a few months affect our patients adversely, psychologically and physically? The simple answer is Yes. Will the stage of the cancer escalate sharply in all patients? Yes. Will we shortly face a spate of untreatable advanced malignancies? Yes.
Cancer care, especially surgery for the poor, has been unceremoniously pushed into a near oblivion state in this COVID period. With the exception of sterling institutes like the Tata Memorial Hospital and a few other stray hospitals, patients are confounded by logistic issues like: Which hospital can I go to? Where can I go? How do I go? How will I travel? Where will I get a place to stay? And how long can I wait before my disease incapacitates or kills me?
General and smaller private hospitals which used to offer good cancer care to a sizeable number of patients, are ordered to hand over 80 per cent of their beds to COVID cases. The remaining 20 per cent beds have to be shared between non-oncology and oncology patients. Oncologists and oncology students are diverted from their primary duties, and are now caring only for patients with this highly infectious viral disease. The COVID pandemic has drastically locked out cancer care.
India had an estimated 1.16 million new cancer cases in 2018, according to the World Health Organisation, which calculated that one in 10 Indians will develop cancer during their lifetime and one in 15 will die of the disease. Of these new cases 2,25,241 will be tobacco related head and neck cancers, and roughly 93,563 women will be diagnosed to have breast cancer this year. Estimated number of people living with the disease is around 2.25 million, and cancer-related deaths are 7,84,821. We cannot ignore these numbers, even in the midst of a pandemic. Quoting Richard Franki from Oncology Practice, “More than 80,000 diagnoses of five common cancers may be missed or delayed by early June in the US, because of disruptions to health care caused by the COVID-19 pandemic. Thousands of people with cancer will die early, because so many hospitals have suspended surgery for the disease.” If surgeries are delayed for three months, 10-15 per cent of people who could get cured, will not, and if delayed for six months, then 25-30 per cent will suffer irrevocable impairment.
For a populous country like ours, Indian oncologists still save lives, and the care given is as good as the best in many Indian centres, particularly in metropolitan cities. By turning a deaf ear to cancer, the scene will escalate from being “just grim” to “catastrophic”, in terms of suffering, morbidity and mortality.
At present, across the country, we are suddenly doing little or nothing for cancer victims. Cancer has many different faces, many speeds at which it progresses, and varied end results. The quick killer cancers are still the ubiquitous mouth and throat cancers, brain, breast, stomach and pancreatic cancers. Rapidly growing progressive cancers can gallop fast to kill patients within weeks or months. Untreated cancers will inevitably end up with advanced disease, when only palliative care will be possible.
Is there a cure for cancer? There are many available cures for cancers. Yes, it is not always a win-win situation, but there are phenomenal successful cures for some cancers, like childhood and germ cell tumours, early breast and colon cancers. All cancer specialists stress that cure is possible when patients come early. Cure becomes almost impossible with advanced disease. Cancer kills almost 100 per cent of untreated patients and produces unimaginable physical and mental suffering.
Can the COVID-19 phenomenon be ignored? It is an infection which can debilitate those afflicted, and in the Indian population it can cause death in about 3 per cent of patients. About 80 per cent of our confirmed cases recover without any serious complications. So, though COVID-19 is not a huge or consistent killer in our population, there is no getting away from the fact that it has potential to kill, and every life lost is one life too many. Hospitalisation and nursing care are indeed indicated. But does it have to be at the cost of all other diseases?
So, can we not think of a balance of forces? Can the government think of allocating some good dedicated hospitals with expertise to exclusively continue oncology work? COVID will go away some day. But the damage done to cancer will be irretrievably severe for years to come. So, my plea remains, let’s please get in some balance into the health care system. We need a very enlightened medical think tank in the echelons of the powers that be.
The world has taken this virus very seriously, and the fear it has generated has outstripped even the other older fears of tuberculosis, and cancer. How did we forget cancer? What happened to us? Is this just a hype about a novel virus, or is this an over-reaction to something that happened in another country? Is this fear justified? Only time will tell.
We cannot allow the Emperor of Maladies to be dethroned, and neither should we allow the emperor to become the lackey of Yamraj.
This article first appeared in the print edition on June 6, 2020 under the title ‘Kicking the cancer can’. The writer is a cancer specialist in diagnostic pathology. She trained and worked at the Tata Memorial Hospital (TMH) for over 32 years and now works in Prince Aly Khan Hospital in Mumbai.
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