As COVID-19 cases surge, it is still unknown how to treat Cancer patients suffering from COVID. Republic Media Network posed some of the most common questions to India's leading medical practitioners-- Dr BS Ajaikumar, Executive Healthcare Global Enterprises and Dr Shailesh V Srikhande-- Deputy Director, Professor & Head of Cancer Surgery at Tata Memorial Hospital.
Dr Shailesh V Srikhande said, "I don't think we have a very clear answer for that because within cancer patients there is a large spectrum. Speaking about the patients who do not have any ongoing active treatment, their immunity recovers quite well and they are able to deal with COVID as any other normal patients would. On the other hand, if they are taking any active cancer treatment-- there are different kind of Cancers where it is not high risk and there are ceratin cancers and certain treatment mortalities during which time they are more at higher risk. So it very individual for every given case. We in Tata have been continuing treatment throughout for all the cancer patients who are reporting or consulting us".
Dr BS Ajaikumar said, "We have a number of Cancer patients infected by COVID if compared to the last wave this time we have witnessed more patients. We are encouraging them not to delay the treatment. In the last wave, we learnt how to manage COVID patients and by using that knowledge we have been very successful in treating Cancer patients-- not stopping treatments, chemotherapy, surgery, radiations at the same time managing their COVID. In fact, we have COVID cancer patients, we wait for them to become COVID negative and then perform the surgery and chemotherapy whereas for radiations there is minimal interruptions and it can be continued. The whole idea behind this is Cancer collateral damage should not happen. Cancer patients with symptoms should not delay coming forward. Last year, 20 to 25% of cancer patients had issues and came after 3 months that should not happen. Do not delay, addressed it to the Doctor".
Dr Srikhande explained that "Chemotherapy is known to depute and depresses the immune system is an acknowledged fact but having said that the same precautions that are taken for the COVID can be taken during this time. There are principally only three things: Masking, Hand Hygiene and Distancing. Apart from this patients has to ensure to take nutritious diet and take care. So can Chemotherapy increase the risk-- it is more theoretical as there are a number of patients where we are continuing the Chemotherapy and we have not had any problem in terms of the increase and spike of COVID infections.
There are certain cancer cases where we can't afford to wait and this happens especially in the pediatric age group. There are certain cancers like Leukemia where even with the COVID infections we are able to continue Chemotherapy and the results at the Tata Memorial have been extremely encouraging. So I want the audience to also know there is certain cancer wherein the presence of COVID infections we are able to continue the Chemotherapy because we can't delay it. But there is something known as elective Chemotherapy then, of course, we can delay it for 2 or 3 weeks till the infection subsides".
Dr Ajaikumar stated, "If they are infected with COVID and once they turn negative, I think they are treated as normal and we expect their antibody level to be high. So their chance of developing second COVID infections is very minimal, at least for several months and the right time also to consider vaccination for them. What we are noticing is that people getting infection after the vaccination are getting mild symptoms. We have collected the data of those patients in our Healthcare Global Enterprises database, we have found nearly 80% of the people who are vaccinated developing very mild COVID. None of them has really required hospitalisation and no mortality at all. So this really shows the importance of vaccination particularly in patients with cancer, diabetes and other things that have to be done as quickly as possible. Then with that continuation of the treatment becomes very vital. This is still a study we are collecting lots of data on that, not only among the patients but employees who have got mild COVID after vaccination. The infection after the vaccination becomes like common cold and flu but still contagious. In the USA also they have addressed the same situation. So, for the cancer patients, it will definitely be helpful to give them both doses of the vaccination as soon as possible".
Dr Shailesh said, "As I mentioned earlier, those who are under active treatments I think they would require a degree of reassurance and some extra care. For example, if the patients are affected by the COVID during the therapy, of course they need to be isolated and the usual COVID norms should be followed. We not only have to take care of the patients but also reassure the family and then have to continue with the Standard COVID measures and hopefully, a large number of them will be recovering-- that is our documented experience at Tata Memorial, not just this year but also last year. Last year in 5 to 6 weeks into lockdown Tata Memorial conducted 500 surgeries without single mortality. That's because we could segregate our hospital care from those patients with COVID & Cancer to those patients with only cancer. The whole purpose was that Cancer doesn't wait and we can't always wait for the COVID to go away and then continue. On one hand, continue vaccine and on the other hand, continue anti-COVID measures and in parallel to continue with cancer treatment as well".
Dr Ajaikumar assured and said, "Definitely not in my view, particularly today the exposure of radiations from CT Scans is very minimal. There is actually a paper out which shows that the number of radiations that we receive from our environment might be more than what a CT Scan does. In the newer units are very low in terms of radiation intensity. Cancer to come from the radiation itself will take decades. So, I don't think there is any evidence that it causes any problem with cancer. On other hand, there are some recent reports which I am not advocating just sharing my experience: I got a call from a very prominent radiation oncologist who said that there is a paper out which tell radiations can help control COVID. There are lots of trials, reports, news, and fake news going on. One should be very clear that it has to be evidence-based. But until firm data evidence-based data is available we should not believe such studies. We can not say that the repeated CT scans can increase cancer, it is wrong assumptions and sends the wrong message to the patients. As there are no evidence people patients should not hesitate to get a scan done when needed".
Dr Srikhande stated, "I think it's very clear that there are certain guidelines just because you are RT-PCR positive. On one hand, you should not go to extreme end of the pendulum just because you have tested positive-- rushing towards CT Scan. So overuse of CT Scan will be using of technology that is not evidence-based. It is good technology and does give rise to the degree of radiations but which is extremely small. Wherever appropriate CT Scan must be used. Nowadays we should refrain from doing such things which spreads negativity or panic situation in society. Do not overuse as anything overused has bad effects. But, I don't think we need to be worried about it".
(Image Credits: RepublicWorld)