By Dr Vineet Datta, MD, MCEM (UK), FRCP (Glasg), FIMSA, CMQ/OE ASQ.
As we continue to grapple with one of the biggest crisis ever witnessed in our lifetimes with the global Corona virus outbreak, there should be no doubt that events like these tend to change the landscape of the world, in ways nobody anticipated. The healthcare ecosystem is already struggling to cope with the management of the current pandemic, and our global unpreparedness is evident from the struggle healthcare workers and responsible governments continue to face every passing day. Adequacy of personal protective equipment, national frameworks to effectively undertake gap pandemic analyses and integrative execution of response strategies have varied from country to country. One of the key areas of focus has been on how to survive this pandemic with the least possible damage to our own health and that of our patients. The burden for noncommunicable diseases (NCDs) has been rising at a rapid rate and as many as 60% of the global deaths are due to these NCDs like stroke, most cancers, cardiovascular disease and diabetes. A majority of these conditions are lifestyle related and preventable, if detected in the early stages of their insidious development. In nations, where cancer screening strategies are less developed, the socio-economic impact is more profound.
By mid-April2020, the spread of the Coronavirus had resulted in over 2 million cases and 130,000 deaths across the world. Even as a major part of the world population has been on some form of physical lockdown over the last few weeks, the lack of easy access to healthcare services has resulted in new and serious challenges for patients, especially the cancer community. With the arrival of the Corona virus, clinicians now battle cancer, not just to fight off and limit the disease, but also struggle to execute optimal clinical care for suspected and existing cancer patients in a dangerous and uncertain ecosystem. Some data suggests patients with cancer are at higher risk of developing a more serious and life threatening Covid-19 illness. As we await more data, the current start-stop-delay-suspend approach increasingly creates confusion and a valid concern for both patients and their caregivers. As increasing number of facilities service COVID-19 patients via an overworked and near exhausted healthcare ecosystem, it continues to add to the woes of the cancer patient. Possible delays towards diagnosis in suspected patients, delays in scheduling imaging and physical biopsies, postponement of chemotherapy sessions, possible enhanced risk of nosocomial infections and increased piling of patient cases awaiting definitive treatment can’t be good news.
Increasing age, clinical co-morbidities, and immunosuppression place cancer patients at a higher risk for severe illness. Preliminary data, though limited, indicates poorer outcomes from COVID-19 for cancer patients, and also suggests that these patients require earlier interventions to minimise rapid deterioration. While further data is awaited, initial analysis suggests a higher risk for cancer patients for intensive care, ventilatory support and death. Obviously more data will assist us to make more meaningful analyses.
While each cancer is unique, as is the patient, clinicians need to advise their patients on therapy options, the pros and cons of delaying treatments and decide if patients stay at home to limit their exposure to coronavirus, or continue with cancer treatment as planned. Accessing healthcare facilities may increase the risk of Corona virus exposure for cancer patients and their accompanying caregivers, especially when inpatient services like surgeries or management of complications are warranted. Disruptions to the healthcare environment have limited the available opportunities for enrolment of cancer patient into clinical trials during the pandemic, especially for those already enrolled and worrying about the continuity of their trial interventions. It also remains critical to ensure that the global supply chain of essential cancer drugs remains uninterruptedly available across countries for the continuous supply of medical supplies to cancer patients. An integral strategy to protect patients is also to ensure protect pion of our healthcare staff though appropriate training, provision of personal protective equipment, easy access to testing and psychological support.
Various countries have used a range of technologies in their fight against the pandemic, including enhanced surveillance, robots and drones, smart imaging, home healthcare and advancing access to telemedicine healthcare services. It seems sensible to advise cancer patients to limit hospital visits to minimise their possible exposure to other infections. Early diagnosis of key individual risk factors is crucial for improved prevention of serious illnesses. Every individual is unique with their own constitution, risk factors and genetics. Genetic research has rapidly increased the opportunities for incorporation of innovative solutions in clinical practice. Through the adoption of blood-based genetic solutions to treat some of the most complex conditions is evolving, the solutions offered today outsmart those that were available just a few years ago. Technological advances are today facilitating the discovery of better biomarkers, making earlier and focused treatment opportunities possible. Clinicians can today use the blood drawn from a patient to analyse tumour fragments that are typically shed into the bloodstream. Depending on the tumour, these bio-analytes like DNA, RNA and cell fragments provide a non-invasive approach to tumour molecular profiling without having to obtain tumour tissue. Liquid biopsies offer an effective utility to better understand the molecular aspects across the cancer spectrum, offering diagnostics to cancer patients from the comfort and safety of their homes. This can significantly benefit patients by minimising their risk of exposure to the Corona virus, by allowing them to effectively continue social distancing.
At a time when access to current healthcare resources remains a challenge, we need to be open to the adoption of credible and evidence based innovative technologies that utilise promising non-invasive tools in the scenario of cancer, like blood based tumour evaluation for cancer diagnosis where physical biopsies may not be feasible, accessible or inadequate tumour content obtained on physical biopsy. Molecular science continues to offer enormous potential in transforming the current strategies undertaken to prevent, diagnose and treat cancer. Genetic research over the past few years has rapidly increased the incorporation of such solutions in clinical practice, but much still remains to be done.
One the current pandemic is overcome, the world on the other side may well be very different to the one we have previously lived in till now. It is certain to throw up new risks and opportunities for all aspects of healthcare, especially cancer care. There has been an unprecedented loss of life for patients and healthcare workers due to the current pandemic. We must learn from this pandemic, and have a long way to go, but only sustained commitment and determination, armed with credible science and innovation will take us on the right direction.