The decline in India's cancer care services due to the COVID-19 pandemic will have dire consequences -- India could witness 98,650- 1,31,500 excess cancer-related deaths in the next five years, shows a Lancet Oncology study by several researchers as part of National Cancer Grid of India.
The second wave of the COVID-19 pandemic hit India hard and adversely affected cancer care. It has led to 83,600 to 1,11,500 missed diagnoses which will result in worsening of the disease in the next two years, it said.
The study found that cancer management during the pandemic was substantially affected and most of the population had inadequate access to cancer care. About 69 per cent of the centres had stopped or reduced cancer screening activities during March-May 2020 as compared with the same period in 2019.
Cancer research also reduced by 69 per cent, and educational activities continued in only 56 per cent of the centres. About 88 per cent of the centres provided data on staff sparing strategies and teleconsultations or video consultations to help mitigate the reductions in outpatient services.
Further, about 69 per cent of the centres reported a decline in hospital income between April and May, 2020, while 85 per cent of charitable hospitals and 75 per cent of private hospitals reported a decrease in hospital income, the study said.
The study was conducted at 41 cancer centres across India which are members of the National Cancer Grid of India.
Between March 1 and May 31, 2020, there was a substantial decrease in patient numbers across all cancer care services compared to 2019. New patient registrations fell by 54 per cent. For the period April to May 2020, total outpatient visits, and surgeries reduced by more than 60 per cent.
The study found that the reduction in patients accessing oncology services was higher in tier 1 cities than in tier 3 cities, with 50–75 per cent reductions observed in almost all services provided in cancer centres in tier 1 cities between April 1 and May 31, 2020.
The high absolute numbers have posed a major challenge to existing health systems that are reeling under the pressure of a double disease burden of infections and non-communicable diseases, the report said.
In India, more than 1.3 million new patients are diagnosed with cancer, and over 8,50,000 patients die of the disease annually. Cancer contributes to 8 per cent of adult deaths, with the mortality to incidence ratio for cancer higher than in India than in high-income countries.
The COVID-19 pandemic further exposed vulnerabilities and adversely affected cancer care.
Delays in cancer treatment are known to have a detrimental effect on cancer outcomes: every month’s delay in accessing or starting treatment results to 6–8 per cent increased mortality for patients requiring surgery, the report said. It substantially increased mortality in those requiring radiotherapy and chemotherapy for specific indications.
"Poor access to palliative care and opioids, which existed even before the pandemic, has been exacerbated in the past year and a half," says the study.
One of the least recognized fallouts of the COVID-19 pandemic was on medical training, which will likely compromise outcome of cancer care in the future.
Most Indian hospitals cut down training schedules due to time constraints and to ensure physical distancing. With some cancer centres being converted to COVID-19 facilities, trainees have had considerably reduced exposure to management of cancer, the report found.
Furthermore, biomedical research, clinical cancer research and funding was reduced drastically during the pandemic due to research facility lockdowns, halting of clinical trials and the urgent essential diversion of funds to COVID-19-related research.
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