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.