Continuing cancer surgery through the first six months of the COVID‐19 pandemic at an academic university hospital in India: A lower‐middle‐income country experience

Abstract

Background The novel coronavirus pandemic (COVID‐19) hinders the treatment of non‐COVID illnesses like cancer, which may be pronounced in lower‐middle‐income countries. Methods This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID‐19‐related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. Results From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% — 14.12%). Postoperative complications were similar (p = .593, 95% CI: −2.61% — 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID‐19‐related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID‐19‐related mishaps were averted. Conclusions We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID‐19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.

The Impact of the COVID-19 Epidemic on Diagnosis, Treatment, Concerns, Problems, and Mental Health in Patients with Gastric Cancer

“…Delay and discontinuation of treatment mainly include chemotherapy, and immunotherapy has been observed [ 21 ]. In addition, outpatient consultations, admission of hospitalized patients, the performance of the chemotherapy, and surgeries have decreased [ 20 ]. Patients’ treatment switched from intravenous to home treatment was other change.…”

“…COVID-19 has led to more occupation of ICU beds; therefore, patients with cancers are usually not a priority for admission to the intensive care unit [ 33 ]. During this period, the performance of chemotherapy and surgery units decreased, hospital inability to provide services, transportation problems, patient perception of infection risk, financial issues, and lack of perceived social support of patients are its causes [ 20 ]. People with active cancer are one of the most at-risk groups for severe COVID-19 disease.…”

“…A total of 22 studies were eligible for the study according to the objectives of the study and were divided into four categories. The effect of COVID-19 epidemic on the diagnosis of gastric cancer [2,4,5,[15][16][17][18][19], treatment and follow-up [1,[20][21][22][23], problems and concerns of patients with gastric cancer [20,21,24,25], and health psychiatry of patients with gastric cancer [1,25,26].…”

“…Patients' treatment switched from intravenous to home treatment was other change. A total of 89.2% of patients with gastric cancer reported receiving at least one supplement or alternative [20] India Retrospective cohort study Good In 2020, outpatient counseling, patient admission, and chemotherapy unit performance decreased by 62%, 58%, and 56%, respectively, compared to the same period of the previous year In the treatment of cancer, major surgery was reduced by 31% and cosmetic surgery by 45% Admission and physical therapy have decreased by more than 50% Takahari [22] Japan Experience in The Cancer Institute Hospital Fair Due to the severity of the COVID-19 epidemic and the presence of risk factors such as age over 75 years, comorbidities such as hypertension, diabetes, lung, kidney and liver problems, it is recommended to change the treatment Erdem [13] Turkey Prospective cross-sectional study Good During the study on 300 patients, receiving medical services was difficult due to the risk of infection, some on the advice of a doctor, some due to fear of delay in receiving treatment. 71.3% of patients started taking the supplement with their decision Aznab [31] Iran Retrospectively study Good In 279 evaluated patients with cancer were during a 90-day period.…”

“…Increased sense of threat, vulnerability, and fear of COVID-19 disease have been other problems for patients [24]. Transportation and financial issues have also been a problem for patients and patients undergoing surgery; in addition to the mentioned issues, there has been a lack of social support [20]. Patients' sense of vulnerability was associated with variables such as female gender, chemotherapy, and age over 65 years.…”