COVID-19 and haematology services in a cancer centre from a middle-income country: adapting service delivery, balancing the known and unknown during the pandemic

Abstract

The COVID-19 pandemic has caused major disruptions in multiple spheres of healthcare delivery in the world. Developing nations have had to tackle this unanticipated crisis in the midst of various other healthcare delivery issues and resource constraints. As a tertiary level cancer care provider located in an eastern Indian city, a COVID-19 hotspot, we share our experience from the perspective of haematology and haematopoietic stem cell transplantation (HSCT) services. The primary challenges related to infection control included infection screening and decreasing exposure among patients and healthcare workers. Logistic challenges include maintaining essential patient care services, personnel redeployment, blood bank inventory constraints and maintaining the supply chain for a continuum of care. Clinical management challenges were dealt with by rationalising treatment delivery by modification of treatment regimens, risk-based deferral of HSCT, management of COVID-19 in patients, and staggering the follow-up schedules in survivors and those on maintenance therapies, among other strategies. These challenges were compounded by the restrictions imposed by a countrywide lockdown in the initial period of the pandemic, which also affected the socio-economic aspects of treatment delivery. As a training institution, this period also impacted academics and research activities. This overview details our response to these challenges during the COVID-19 pandemic, which has many unknowns.

Oncology provider experiences during the COVID-19 pandemic

“…We identified ongoing concerns as states remain under restrictions and as the U.S. begins to emerge from the pandemic. In terms of practice changes, similar to our findings, other studies have also reported delays to cancer treatment for older adults [ 14 , 19 ] and appointments for cardio-oncology [ 20 ], as well as for treatment of hematological malignancies in one middle-income country [ 21 ].…”

Impact of COVID-19 in pediatric oncology care in Latin America during the first year of the pandemic

“…The COVID-19 pandemic is an unprecedented global crisis that impacted pediatric cancer health care systems worldwide, with a greater effect on low and middle-income countries (LMIC). 2,3,12,[15][16][17] One year into the pandemic, the initial fears and concerns have evolved along with treatment and prevention strategies for COVID-19 and multiple effective vaccines have been developed in record time. As the pandemic continues to unfold, our 4 surveys performed over the first year of the pandemic in Latin America show the mediumterm effects on the care of pediatric cancer patients; and reveal how the medical systems and medical professionals adapted to the different health care crises that originated from the pandemic.…”

“…1 One year into the pandemic, multiple measures were implemented by governments attempting to slow the spread of COVID-19 and to ameliorate the burden on their medical systems. 2,3 These included home isolations, closing borders, schools, nonessential business, and restricting travel within and between countries. The fear generated by the pandemic resulted in patients being unable or unwilling to seek medical care.…”

Impact of COVID‐19 in pediatric oncology care in Latin America during the first year of the pandemic

“…The COVID-19 pandemic is an unprecedented global crisis that impacted pediatric cancer healthcare systems worldwide, with a greater effect on low-and middle-income countries (LMIC). 2,3,12,[15][16][17] One year into the pandemic, the initial fears and concerns have evolved Therefore, the answers to our surveys reflect cautionary adaptation, as most medical systems organized to face unpredictable healthcare delivery crises. Not surprisingly, higher levels of treatment disruptions were reported in countries with HCE below 7%, and in countries with higher national burden of COVID-19, reflected by a higher incidence rate and case fatality rate above 2%.…”

“…Severe acute respiratory virus (SARS‐CoV‐2) outbreak resulting in coronavirus 2019 disease (COVID‐19) caused an unprecedented pandemic that led to more than 400 million cases and close to 6 million deaths around the world (date March 7, 2022) 1 . More than 1 year into the pandemic, multiple measures were implemented by governments attempting to slow the spread of COVID‐19 and to ameliorate the burden on their medical systems 2,3 . These included home isolations, closing borders, schools, nonessential business, the use of personal protective equipment (PPE), and restricting travel within and between countries.…”