Impact of COVID-19 on cancer care in India: a cohort study

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Results

Between March 1 and May 31, 2020, a substantial decrease in patient numbers was observed across all oncology services compared with the same period in 2019 (table 2). The largest decrease was observed in the number of new patient registrations from 112 270 to 51 760 (54%). The reduction in the number of patients receiving radiotherapy and palliative care were less marked than for the other services. For the period April to May 2020, the overall reduction in patient numbers across all oncology services was even more marked when compared with the same period in the previous year, especially for new patient registrations, total outpatient visits, and surgeries, which reduced by more than 60% (table 2). The percentage reduction in the number of patients accessing oncology services was higher in tier 1 cities than in tier 3 cities, with 50–75% reductions observed in almost all services provided in cancer centres in tier 1 cities between April 1 and May 31, 2020 (table 3). The reductions in patient numbers were larger during April 1 to May 31, 2020 versus 2019, than during March 1 to May 31, 2020 compared with 2019 (appendix 2 pp 3–8). Public and charitable hospitals had larger reductions in patient numbers than did private hospitals between March and May, 2020, when comparted with the same period in 2019 (appendix 2 pp 1–2, 10). No clear differences in patient numbers were identified between oncology-specific centres and multispecialty hospitals (appendix 2 p 11).

Table 2Provision of hospital oncology services between March 1 and May 31, 2020, compared with the same period in 2019 across all participating centres

Table 3Percentage reductions in provision of hospital oncology services between 2020 and 2019, by city classification

Our estimates based on results from scenarios 1 and 2 indicate that these declines in cancer service usage will result in 83 600 to 111 500 missed diagnoses, lead to 83 600 to 111 500 patients requiring oncology services for more advanced disease in the next 2 years, and 98 650 to 131 500 excess cancer-related deaths occurring in the next 5 years.

32 (78%) of 41 centres provided data on activities associated with screening, research, and educational activities (appendix 2 p 9); 22 (69%) of 32 centres had stopped or substantially reduced cancer screening activities from March to May, 2020, compared with the same period in 2019. Substantial reductions in research activities were observed in 22 (69%) of 32 centres, and marked reductions in educational activities were reported in 18 (56%) centres. 36 (88%) of 41 centres provided data on staff sparing strategies and teleconsultations or video consultations: 31 (86%) of 36 centres implemented a conscious staff sparing strategy during March to May, 2020, and 24 (67%) centres initiated teleconsultations or video consultations to help mitigate the reductions in outpatient services. 29 (71%) of 41 centres reported data on income changes; 20 (69%) of 29 centres reported substantial declines (50–75%) in hospital income between April and May, 2020; a higher proportion of charitable hospitals (11 [85%] of 13) and private hospitals (seven [75%] of ten) reported a decrease in hospital income than did public hospitals (two [33%] of six).

Discussion

The results of our study done at 41 high volume cancer centres in India showed considerable reductions in the provision of oncology services between March and May, 2020 compared with the corresponding time period in 2019. The reduction was the largest for new patient registrations, outpatient services, hospital admissions, and major surgeries, and less marked for radiotherapy and palliative care. Reductions were highest in April and May, 2020, when the lockdown measures were most stringent. Considering that the national lockdown was announced on March 24, 2020, the lower patient numbers in March were more likely due to fear of infection, whereas reductions in April and May are likely to reflect a combination of fear of infection and the logistical restrictions due to the lockdown. Larger reductions in patient numbers were observed in major cancer centres located in larger metropolitan cities than in smaller cities. Our estimates of missed cancer diagnoses, delayed diagnoses, and subsequent burden on health-care services and the probable overall impact on cancer mortality indicate the possibility of a serious public health problem in the next 5 years. Education and training sessions for oncology and allied trainees were held less frequently than the same period in 2019 in most centres. Cancer research activities also decreased compared with the pre-COVID-19 period. Overall, cancer care services decreased considerably across centres regardless of geographical location or city classification. Many centres adopted teleconsultations and video consultations quickly to mitigate the effects of these reductions in hospital outpatient visits, and most centres also had reduced incomes during these months.

Cancer represents a complex set of conditions with outcomes that are dependent on the timing of diagnosis and treatment. The ability to provide cancer services during the pandemic has been affected in several ways.

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  • Alom S
  • Chiu CM
  • Jha A
  • Lai SHD
  • Yau THL
  • Harky A
The effects of COVID-19 on cancer care provision: a systematic review.