Dr Kanchan Kaur
Cancer care in corona times … balancing the actual threat of one disease versus the potential threat of another.
As a doctor who deals with cancer, the moral dilemma of triaging treatment strikes deep at the moral core of my doctor heart .
The wildfire like spread of this dreaded virus has put treatments of patients with chronic ailments on the back burner. Particularly so for cancer patients, this has come as a double blow.
Oncologists across the world are faced with walking the tightrope on deciding which cancer patients merit urgent care and who can have their treatment deferred till the risk of visiting a hospital becomes lesser than the risk of the disease itself.
Postponing treatment for a few weeks may not have medical repercussions, but the emotional trauma that comes with waiting for definitive treatment for the cancer can be quite devastating, to say the least .
Culturally, most Indian patients are inherently ill equipped to deal with the word cancer at an emotional level . They will not come in time and there is no dearth of “quack” opinions that they might get misled by.
Sadly ,as cancer statistics go , majority of our patients present in late stages. Fear of this C word (cancer) is the biggest reason that keeps them away . Now couple that with the fear of catching the other big C (corona) and you have a dangerous scenario where patients might themselves delay seeking treatment .
Guidelines suggested by western counterparts , where majority of cancer is detected in early stages ,can’t be extrapolated to the Indian scenario. Our guidelines on how to deal with the situation in these unprecedented times come with the caveat that even in normal times, cancer care in our country is not standardised and the quality of treatment, patient attitude and understanding of the disease greatly influence treatment outcomes ( negatively so in many cases).
And if things were not complicated enough, we have more issues to deal with .
In providing cancer care at this time, and by using PPE while doing so, are we( oncologists) wrongly channelling this scarce resource which is undoubtedly more urgent for the medical warriors on the frontline?
Also, medicine over the past few decades has sadly evolved from being a relationship of utmost trust between the provider and the patient , to that of a transaction of service ! Legal documents are signed before any treatment is instituted . The ‘pious’ doctor -patient relationship , the noblest of all relationships where one human places his life in the hands of another mortal ,is shrouded in the cape of legality. Corona times being no different, patients are being made to sign forms stating that they will not hold the hospital responsible if they catch the virus while being treated for another disease .( this following cases of hospitals being sued by patients for the same)
While everyone wants to be safe, this does little for the confidence of both the patient seeking treatment and the clinician providing it!
As a doctor who treats cancer I don’t know what advise to follow. Most of our patients travel from across the country, from small towns , seeking treatment . How do you tell them to go back and wait for this to tide over! What support do they have in their community to deal with the emotional compromise of living with the cancer till they are able to treat it at a place that they deem would be best for them ?
On the other hand, if me and my team step forward and offer treatments , some of which particularly chemo-therapy will leave them immunocompromised (and potentially more exposed to the risk of CVID 19 ), are we doing more disservice than good?
It’s a cliched ‘catch 22’ situation !
Till we see light at the end of the tunnel, doctors have to be the torchbearers of light, hope and support for vulnerable patients of other diseases. We have to individualise treatments , sometimes outside the remit of what are accepted guidelines during normal times.
In a country like ours where medical support is always more tertiary hospital based , we will have to go out of the way to provide extensive counselling and support in the community .
I can only hope …hope that this too shall pass and we shall overcome.
(The author is Director-Medanta Division of Breast Cancer Services)
Dr Kanchan Kaur