By Dr Amit Jotwani
For the first time, in the past 100 years, the world in all its entirety has been forced to come together to fight a lethal global pandemic. The COVID-19 pandemic has made us all take stock and look at life in a whole new light. The impact is not only enormous, but unfortunately still unpredictable given the fact that the understanding about this disease is still evolving. With the lockdown in India slowly shifting and peoplesâ€™ lives limping back to the new normal, social distancing during the public health emergency has become imperative, especially for individuals with underlying health disorders or vulnerable immune systems. Cancer patients qualifying on both counts are at the receiving end of this crisis given their vulnerabilities to both COVID and cancer.
As per data published in international journal â€śThe Lancetâ€ť, it was reported that between 7.5% to 20% COVID-19 deaths in China and Europe were active cancer patients. This points to a grave risk carried by cancer patients and calls for extra caution. Cancer patients generally have reduced immunity owing to treatment effects and a lot of times their nutritional status is quite weak making them further vulnerable to COVID-19 complications.
Cancer care in India has taken a severe hit due to the current lockdown situation and patients have been unable to continue their treatment due to two main reasons. Most of the senior qualified oncologists practice in tier-1 cities and hence a lot of patients who normally travel from smaller cities and towns to avail treatment in metro cities are unable to do so due to travel restrictions. Secondly, many cancer hospitals had minimised their staff activities and placed preventive protocols including postponement of major surgeries, tapering of chemotherapy regimens to milder drug combinations and postponement of definitive radiotherapy treatments. There is a lot of heterogeneity between doctors and hospitals in terms of their policies with some continuing to provide uninterrupted care while some of them choosing a path of altering the treatment plan to avoid COVID-19 risks.
At a time like this, digital health and telehealth solutions have come to the rescue of cancer patients and now they are able to tele-consult senior oncologists from metro cities and are able to get guidance around the treatment plan they need to follow with doctors locally. More and more doctors and patients are opening up to telemedicine services and are trying to help patients maintain continuity of care. This has helped remove initial reluctance and doubts about the concept of telemedicine and we would see increasing use of these services for different clinical situations in times to come.
In a recent report by McKinsey, it is stated that telemedicine and an overall digitised healthcare model will enable India to save up to $10 billion by the year 2025, if telemedicine were to replace 30% to 40% of in-person consultations.
In a welcome move, on March 25, 2020, the Medical Council of India released long pending regulations for telemedicine and telehealth. This has resulted in enhanced adoption of telemedicine among doctors and patients across the world. In India only, as per some estimates, more than 5 lakh telehealth consultations have been done in the past 2 months. More than 2,000 cancer patients and their caregivers have reached out to oncologists through platforms like Onco.com and have got treatment guidance even during lockdown.
This has helped them mitigate anxiety due to delay in treatment as they were advised treatment options that could be availed locally with minimum risk of exposure to COVID-19 infection. As cancer continues to grow, any delay in treatment can have a direct impact on long-term survival of patients and telehealth has come to the rescue for a lot of patients who needed to continue their treatment.
Cancer and its intervention is in many ways well-suited for telemedicine or at least for expert second opinions given the seriousness of the illness that requires consideration of the multiple treatment options available; and that it requires a well-planned approach from the beginning. Majority of treatment decisions taken by oncologists are cognitive in nature, based on the careful consideration of multiple reports especially pathology (biopsy, IHC, genomic) tests findings or imaging (PET-CT, MRI etc.), along with their understanding of patientâ€™s condition, and then coming up with an in-depth plan together.
Given that, for cancer, the right treatment is as important as the treatment itself, tele-consultation for cancer patients is particularly recommended for following situations:
> For recently diagnosed patients, an online/teleconsultation with a multidisciplinary tumour board panel of senior expert oncologists can help plan the whole treatment as per standard international protocols and cutting-edge research.
> Advanced stage 4 disease or poor general condition of patient: Such patients are at a very high risk of fatal complications due to COVID-19 and a teleconsultation would help plan and execute treatment with a local doctor.
> For patients already undergoing treatment, a teleconsultation helps validate their ongoing treatment from senior oncologists who specialize in different cancers.
> Follow-up consultation: When one has completed treatment and wants to consult as a follow-up evaluation.
> Ongoing treatment patients can do a tele-consult and understand their options and discuss them with their doctor before making any visit to the hospital.
In coming months as travel restrictions get lifted, we will experience a new normal of social distancing in hospitals where measures like restriction for visitors, prior appointment booking and teleconsultations would be diligently implemented. At the same time personal protection measures would become part of daily routine especially for patients and their families.
Telemedicine and digital health are the best thing to happen to Indian healthcare and realizing the utility of telemedicine will be one small lasting benefit of all of the challenges world is facing, making cancer care and medical care more efficient, patient-centric and data driven, even after the pandemicâ€™s gone.
Views expressed are authorâ€™s own
Dr. Amit Jotwani is the Co-founder and Chief Medical Officer of Onco.com. He is an alum from the Indian School of Business (ISB, Hyderabad) where he finished the Advanced Management Program in Healthcare.