Discussion
Countries across the world are implementing measures from national
quarantines to school closures, to slow down the spread of the
coronavirus. More than a third of humanity is under some form of
restriction.14 A few reports have described cancer
patients in quarantined cities struggling to obtain cancer directed
services and essential medication.15 Over time, this
will exacerbate due to interruptions in scheduled surgeries,
chemotherapy and radiotherapy in order to prioritize hospital space and
care for the seriously ill COVID-19 patients.
Among the cancer patients who develop COVID-19, treatment of the cancer
will be delayed in order to prioritize treatment for the infection. Many
physicians and surgeons around the world are being forced to take this
tough call on an individual patient basis. With these limited resources
and capacity it is important to understand the implications it has on
cancer patients with and without COVID-19. Given the acute time frame of
COVID-19 infection and lack of any retrograde data, a prospective study
of scale cannot be accomplished. The challenge comes about when we need
to triage cancer care during this pandemic. In our analysis we assumed
that patients treated for cancer will have a lesser risk of contracting
the virus at the hospital due to the measures taken by the governments.
At the same time their chances of disease inflammation and death are
relatively high due to the cancer or the treatment received.
The simulated work presented here is to visualize the impact of COVID-19
in the worst case scenario so as to support policy makersmake the hard
decisions. Nonetheless, decisions on patients care is required to be
taken as per the case, rather than abide by blanket guidelines. Due to
the limitation of adequate real world data and follow up on COVID-19, we
cannot provide personalized recommendations regarding cancer care.The
increased mortality of patients seen in this model should caution
oncologists. The risk-benefit ratio should be discussed with patients
before administering any definitive treatment. We propose that forceful
steps are required to reduce the frequency of hospital visits for
patients having cancer during this time.Proper isolation techniques are
required to mitigate the risk of transmission. Risk factors like disease
severity, recent chemotherapy received can increase the chance of
illness and mortality due to COVID-19.It is also required to take steps
to eliminate cross-infection between the patients and healthcare
workers.
With the situation gradually unfolding, there is not much we can do as
health care providers but to adapt as best we can. In case of suspicion,
appropriate isolation techniques need to be instated. Among cancer
patients, receiving recent chemotherapy does increase the risk of severe
illness. This model helps us better understand the survival trajectory
of oral cancer patients that might be affected by COVID-19.