New Delhi,   We face an unprecedented and exponential tsunami of Covid-19 positive, leading to a near-collapse of our healthcare system. Mortality due to the infection is mostly due to severe injury to the lungs causing respiratory failure. With the current shortage of oxygen faced in many hospitals across, the country faces a national emergency causing most of our hospital resources to be directed towards Covid-19 care alone.

Because of this most of the non-Covid-19 emergencies such as myocardial infarction, stroke or cancer care have taken a back burner in most places. Many life saving surgeries have been forced into postponement.

Cancer care has greatly suffered this last one year due to restrictions put on travel, preventing patients from seeking scheduled treatments. In addition, there have been delays in regular follow ups, postponement of scheduled surgeries following neo-adjuvant chemotherapies, unavailability of palliative care facilities, and an absence of cancer screening programs.

There is also a general fear among patients to report to hospital due to risk of getting infected with Covid-19, which has also contributed to further treatment delays. This has resulted in a greater number of cancer patients progressing to advanced stages. The other pressing issue in cancer patients is their lower immunity due to active malignancy and the ongoing chemotherapy which makes them more susceptible to Covid-19 infection.

Below are a few common facts for cancer care during the pandemic:

Should I delay my cancer treatment due to an increase in cases of Covid-19 in hospitals?

It depends on your stage of disease, the treatment should be individualised on a case-to-case basis.

* If you are in early stage of cancer, local treatments such as surgery or radiation may be delayed slightly depending on the risk-benefit based on your general condition and impact of these treatments on you.

* If you are planned for chemotherapy, discuss with your oncologist about options of increasing the duration between cycles, using baxter pumps to deliver chemotherapy at home which is possible in a few chemotherapy regimens (after considering safety issues) or consider switching to oral options where ever possible.

* If you are receiving palliative care, you can discuss options of "drug holidays" (where you temporarily stop treatment where ever feasible) and domiciliary care.

Should I get vaccinated with Covid-19 vaccine while I suffer from cancer and am undergoing chemotherapy?

While there are no safety trials for Covid-19 vaccine in cancer patients, we recommend patients to undergo vaccination as it is proven to be safe in other critical illnesses. If you have recently undergone chemotherapy or bone marrow transplant, we do recommend you wait till your immunity gets better.

What can I do to decrease my exposure in the hospital and reduce hospital visits?

Avail tele-consultations services when it is a routine follow-up with your doctor. If you need to go to the hospital for a physical test or imaging, schedule a prior appointment with your doctor to avoid the waiting time in the hospital. Wear a well fitted mask and maintain 6-feet social distancing from others.

What should I do if I have fever or breathing difficulty?

Report to the emergency immediately to have your vitals (Pulse, BP, temperature and oxygen saturation) checked. The first thing to rule out is Covid-19 infection. Other common causes such as low white blood cell count, other bacterial/viral infections or pneumonia/fluid in lungs due to any other cause will also need to be assessed.

How do I cope with stress during these tough times?

Cancer treatment is itself very stressful and now patients are faced with additional fear of Covid-19. During these stressful periods you can practice deep breathing exercises, gentle yoga, meditation and of course seek help from professional healthcare counsellors.

(Suman S Karanth, Consultant, Department of Medical Oncology and Hematology, Fortis Memorial Research Institute, Gurugram)