Disease progression of cancer patients during COVID-19 pandemic: a comprehensive analytical strategy by time-dependent modelling

Abstract

Background: As the whole world is experiencing the cascading effect of a new pandemic, almost every aspect of modern life has been disrupted. Because of health emergencies during this period, widespread fear has resulted in compromised patient safety, especially for patients with cancer. It is very challenging to treat such cancer patients because of the complexity of providing care and treatment, along with COVID-19. Hence, an effective treatment comparison strategy is needed. We need to have a handy tool to understand cancer progression in this unprecedented scenario. Linking different events of cancer progression is the need of the hour. It is a huge challenge for the development of new methodology. Methods: This article explores the time lag effect and makes a statistical inference about the best experimental arm using Accelerated Failure Time (AFT) model and regression methods. The work is presented as the occurrence of other events as a hazard rate after the first event (relapse). The time lag effect between the events is linked and analysed. Results: The results were presented as a comprehensive analytical strategy by joining all disease progression. An AFT model applied with the transition states, and the dependency structure between the gap times was used by the autoregression model. The effects of arms were compared using the coefficient of auto-regression and accelerated failure time (AFT) models. Conclusions: We provide the solutions to overcome the issue with intervals between two consecutive events in motivating head and neck cancer (HNC) data. COVID-19 is not going to leave us soon. We have to conduct several cancer clinical trials in the presence of COVID-19. A comprehensive analytical strategy to analyse cancer clinical trial data during COVID-19 pandemic is presented.

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19

“…Still, it is necessary to consider that this group may be affected by the scarcity of essential medicines, and may suffer from the reduction of health activities, in the community, due to the implementation of the social distancing and lockdown guidelines ( 6 , 9 ). In some cases, patients may encounter difficulties in carrying out important procedures for their treatments, such as in the case of surgery, due to the high demand for hospitalization due to the pandemic ( 57 ), which may further increase the fear of the progression of the oncological disease ( 26 , 58 ). In addition, a systematic review recently demonstrated that during a pandemic, delay in surgery can reduce survival ( 59 ).…”

“…Undergoing cancer treatment alone generates numerous fears in patients, mainly involving fear of death ( 71 ). As mentioned earlier, during the COVID-19 pandemic, many patients may experience difficulties in accessing their treatments, causing the fear of cancer to progress even more ( 26 , 58 ). In this sense, fear of being infected by the virus is added to the fear that their underlying diseases may become worse due to the lack of adequate treatment ( 72 ).…”

“…In both cases, this can cause a delay in treatment and worsen the prognosis. In addition to clinical issues, this may be associated with high levels of distress and mental suffering ( 22 , 23 , 25 , 26 ). In this sense, risks and fears add up, generating a question: What is the impact of the sum of these fears on the mental health of cancer patients?…”

Impact of Covid-19 Pandemic on the Treatment of Cancer Patients Registered at a Tertiary Care Centre in Eastern India

“…More progression in head neck or lung primary may be due to high tumour doubling time in these sites. A study by Bhattacharjee et al has given an analytical strategy of disease progression based on time dependent modelling during the covid pandemic [14]. However, actual clinical data is limited in the present literature.…”

“…Finally, various measures were taken by institutes treating cancer patients to optimize treatment in the pandemic situation. Among them, some were tele-consultation, using short course radiotherapy to decrease hospital visits, delay treatment if possible, conducting distance screening camps outside hospital etc [9][10][11][12][13][14][15][16]. Such measures could not be implemented in our institute due to a number of hassles.…”