Abstract PO-008: Cancer care during the COVID-19 pandemic in Southern India
Authors: Ramesh Anita , Ssoundarajan Raji 
Published: December 2020

Abstract
Introduction: There is no direct evidence to support changing or withholding chemotherapy or potentially immunosuppressive therapy in patients with cancer during the COVID-19 pandemic. The balance of potential harms that may result from delaying or interrupting treatment versus the potential benefits of possibly preventing or delaying COVID-19 infection is very uncertain due to paucity of literature evidence.
Methods and Materials: Since the lockdown started in India on March 24, in the last 2.5 months we have treated almost 100 patients with cancer on systemic chemotherapy in Saveetha Medical College, ESIC Medical College, and a few private hospitals in Chennai, India. The decision is influenced by the likelihood of cure or extension of life from the cancer treatments, the potential risks of delaying treatment, the patient's tolerance of treatment, the local incidence of coronavirus, and the availability of necessary resources. The number of corona virus testing has increased in India since March 2020. Initially the testing for COVID 19 was done as suspected as per ICMR guidelines, and now we are testing all patients admitted for chemotherapy.
Results: As of June 8, 2020, India has 256,611 cases positive with 124,981 active with recovery 50% and mortality 2.8%. Tamil Nadu ranks as the second highest state in India with 31,667 positive cases, with the city of Chennai at the top of the list. In spite of being in the hot spot, in general out of the 100, 35 patients had adjuvant therapy with curative intent where treated on schedule with growth factor support. For the 40 patients receiving palliative therapy for metastatic and recurrent disease, in some cases delay occurred as 7 patients were unable to travel as there was no transport available to the hospital. Fifteen patients had worsening symptoms and performance status, of whom 10 required hospital admission for supportive care. COVID 19 test was done for all who were admitted to the ICU with symptoms and all were tested negative; 6 died of progressive disease. Two patients with AML/MDS tested positively; repeat test was negative and they were started on chemotherapy. Shared decision-making was paramount, for example, shorter treatment duration was considered in the remaining 18 who continued also oral chemotherapy done in 12 patients. For 25 patients in remission who are receiving maintenance therapy, e.g., breast cancer, prostate cancer, chronic myeloid leukemia, indolent lymphomas, it was reasonable to continue oral drugs. Up to July 2020 the amount of testing increased, but with no alarming rise in cancer patients.
Conclusion: Our data of 100 patients were quite large, with 78% continuing their cancer-directed therapy (35% adjuvant, 25% maintenance therapy, and 18% palliative care) in spite of the pandemic. Six patients died but were negative for COVID 19; only 2 were infected but recovered. We think clinical decisions should be individualized; in India the active cases are high, with higher recovery rate of 50% and low mortality of only 2.7%, and the same is seen with cancer patients where there is no increased mortality as reported in some published literature.
Citation Format: Anita Ramesh, Raji Ssoundarajan. Cancer care during the COVID-19 pandemic in Southern India [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-008.