Oncologists fear delayed cancer diagnosis, stage migration amid COVID-19 crisis

With people fearing about visits to hospitals amid the coronavirus outbreak, delayed diagnosis of cancer and its stage migration could be a fallout of the current crisis, according to senior oncologists.

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While many medical treatments can be put off amid the COVID-19 crisis, "cancer does not wait", oncologists feel.

Cancer treatment in times of coronavirus has been challenging as the pandemic is impacting both cancer diagnostics and treatment, with doctors having to balance risks versus benefits on a daily basis.

Dr Bhawna Sirohi, director of Medical Oncology at Max Healthcare, said cancer is "not going to wait" and the threat from it is "now and real".

"I feel patients, scared because of COVID-19, are not coming to hospitals and that is pushing them from early cancer to late stages," she told PTI.

Sirohi urged patients not to be scared to come to hospitals and if they have a warning sign like a lump, they should not delay treatment.

She said she recently had a patient who ignored symptoms for three weeks and delayed consulting a doctor, but was later detected with cancer.

COVID-19 is here to stay and one just has to get used to the precautions and make it a new normal, she said.

"Stage 1 and 2 (of cancer) can become 3 and 4, it can become incurable, if you don't act upon it," Sirohi said.

Talking about cancer treatment in times of COVID-19, she said a balance has to be maintained between risks and benefits.

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"If the benefit is very small then one should avoid chemotherapy. But if you have a patient with lymphoma or blood cancer then the cure rates are very high, so you would want to go for the benefits," she said.

Dr Akshay Tiwari, Associate Director and Head, Musculoskeletal Oncology, Max Healthcare, said as a bone cancer surgeon he is facing challenges at multiple levels.

Patients are finding it very difficult to travel and even those who have the wherewithal to travel, are scared of coming to the hospital for the fear of contracting coronavirus, he said.

This means that patients who should have been seeking treatment are not doing so and that would lead to stage migration of cancer, Tiwari said.

"Some cases may even become incurable because of the delay. We are fearing this as patients are not coming to us. Similar fears have been voiced by cancer specialists across the world," he told PTI.

The message should go to the public that cancer does not wait and it is even deadlier than COVID-19, the senior oncologist said.

"Diagnosis may also be delayed and that is what is unfortunate. The message needs to go out that we should not ignore symptoms which are remotely linked to cancer for example a lump or swelling," he said.

Dr Rajender Kumar, Additional Director and Head of Oncology at Fortis Hospital, Shalimar Bagh, said the COVID-19 crisis is definitely posing a challenge to cancer treatment as many patients with malignancy in the head and neck area or having lung cancer have symptoms similar to COVID-19.

"We are using all the precautions and the staff is using PPEs as cancer treatment is essential," he told PTI.

Asked whether the COVID-19 pandemic can lead to delayed cancer diagnosis, Kumar said patients are coming to his hospital and their numbers have not decreased, but it is a possibility as most of the routine clinics and hospitals are shut down and people are not going to their doctors.

"We don't have data on it, but it can happen," Kumar said.

Dr Niranjan Naik, Director, Surgical Oncology, Fortis Memorial Research Institute, Gurgaon, said the COVID-19 crisis is posing a challenge as patients with low immunity are at a higher risk of contracting the virus.

He said the key aspect while making decisions is the cancer doubling time which is different for different cancers, with blood cancer being very aggressive as compared with breast cancer.

"Whenever any symptoms emerge, one should get proper medical investigations done even in the present times as cancer will not wait," Naik told PTI.

The oncologists insisted that technology must be used to reach out for medical advice and any symptom must be reported through a video conference appointment or an online OPD.

As the nation fights one of its biggest health battles against COVID-19 pandemic, there are many individual battles being fought by bravehearts, both doctors and patients, to emerge victorious against other life-threatening diseases.