Cancer care during the COVID-19pandemic in Southern India
Authors: A. Ramesh, R. Ssoundarajan
Journal: Clinical Cancer Research (2020)

Introduction: There is no direct evidence to support changing or withholding chemotherapy or potentiallyimmunosuppressive therapy in patients with cancer during the COVID-19 pandemic  The balance of potential harmsthat may result from delaying or interrupting treatment versus the potential benefits of possibly preventing ordelaying 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 treatedalmost 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 lifefrom the cancer treatments, the potential risks of delaying treatment, the patient's tolerance of treatment, the localincidence of coronavirus, and the availability of necessary resources  The number of corona virus testing hasincreased in India since March 2020  Initially the testing for COVID 19 was done as suspected as per ICMRguidelines, 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 mortality2 8%  Tamil Nadu ranks as the second highest state in India with 31,667 positive cases, with the city of Chennai atthe top of the list  In spite of being in the hot spot, in general out of the 100, 35 patients had adjuvant therapy withcurative intent where treated on schedule with growth factor support  For the 40 patients receiving palliative therapyfor metastatic and recurrent disease, in some cases delay occurred as 7 patients were unable to travel as there wasno transport available to the hospital  Fifteen patients had worsening symptoms and performance status, of whom10 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 testedpositively;repeat test was negative and they were started on chemotherapy  Shared decision-making wasparamount, for example, shorter treatment duration was considered in the remaining 18 who continued also oralchemotherapy done in 12 patients  For 25 patients in remission who are receiving maintenance therapy, e g , breastcancer, 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 werenegative for COVID 19;only 2 were infected but recovered  We think clinical decisions should be individualized;inIndia the active cases are high, with higher recovery rate of 50% and low mortality of only 2 7%, and the same isseen with cancer patients where there is no increased mortality as reported in some published literature