View Points in Oncology: Guiding Cancer Care in Coronavirus Disease Pandemic

Coronavirus outbreak has adversely affected the cancer care delivery system apart from affecting the overall health system worldwide. Cancer patients are more susceptible to acquire coronavirus infection and are at an increased risk to develop severe or critical form of COVID-19 [1]. Oncology communities are having a tough time deciding treatment modifications in cancer management in view of paucity of data on different aspects of cancer care. We have evolved from December 2019 till date with many scientific guidelines regarding management of cancer patients in a background of coronavirus outbreak. Different Institutions, Hospitals, Oncology societies have put in their efforts together to formulate guidelines to ensure cancer care delivery at cancer centres.

Practice of oncology is facing many hindrances as lockdown has made it difficult for patients to present to hospitals. Almost all guidelines have advocated to continue cancer treatment with an instruction to avoid unnecessary visits to hospitals to minimise the risk of infection [2]. Oncology is an emerging speciality where facts are changing very rapidly. Cancer, from being a deadly disease, has noted a significant increase in survival for many cancer types and that became a possibility with extensive research for all tumour types.

COVID-19 has affected cancer care delivery and cancer research. Oncology communities have moved from evidence based practices to consensus guidelines. Earlier, new practices were adopted on the basis of results of randomised controlled trials with adequate sample size, but this unprecedented situation has changed our oncology perspective. We need more time to understand the harms and benefits of new practices adopted in our day to day life. Published data on practice modification from different parts of the world is the biggest learning resource to boost our confidence.

Viewpoints have never been considered as a good level of evidence and are the topics we hear being debated in point-counter-points at meetings, are also the subjects of grand rounds presentations, and are the basis of decisions that sometimes give us sleepless night. It is often considered when the controversies in oncology and oncologic science need to be defined, discussed, and debated. As we are fighting a new battle every day with new battle fronts in cancer care delivery, several types of opinion pieces, including Editorials, Commentaries, Viewpoints, Correspondence, Short Communication and Special Report, have gained importance. Each of them is serving a separate purpose to make oncology communities informed for effective cancer care in this crisis.

Viewpoints are strong point of views that provokes the community to think and make a strong stand and question his or her own stand on current issues. In COVID times, viewpoints are helping to set an agenda for cancer care.

To understand the distribution of published manuscripts on management of different cancer types, a systematic literature search was performed using PubMed database using word Cancer, COVID-19 and coronavirus disease on 23rd June, 2020. Out of 734 articles reflected on search, 267 articles were found to be associated with cancer care amidst the current pandemic. All the articles were further analyzed to see the distribution of article types and country of publication to understand the contribution of worst affected countries to guide the rest of the world. We did not consider accepted articles in pre-proof for analysis.

In our analysis, only 14% articles were found to be original articles and were mostly from USA, China and Italy (Table 1).

This reflects that 86% articles were either review, guidelines or recommendations, editorial, correspondence, comment, viewpoints, communications, case report and series, that guided our fight against COVID-19. This pandemic has united us to work together and collaborate irrespective of difference in our sociocultural parameters. More than 5% published data had authors from different nations, showing oncologists have started working across the geography to minimize the challenges and boost the learning from other experience. Out of 19 articles published from India, 2 articles were found to be original study. Maximum number of articles have been contributed by Tata Memorial Hospital, Mumbai. Personal experiences and change in practices at institution level was the only learning resource in this crisis. List of publications in reference to article types and publishing Institutions have been summarised in Table 2.

Many centres have started original studies related to problems they have encountered during this pandemic and outcome of these studies, will certainly help us to modify our cancer care practices in the best interest of our patients. It will be an important task to critically analyse the new problems associated with this crisis to optimise our cancer care facilities. Although this pandemic has made a major disruption in every aspects of cancer care, it does not necessarily mean that cancer care should come to a standstill. Oncologists are trying to overcome many challenges with personalized decision making and by implementing appropriate technological solutions.

This pandemic will probably end in coming times but learnings from this pandemic will certainly help us to formulate future interventions. This pandemic taught us to work in close collaborations, to learn from each other and to help each other to make our science and research useful to combat this crisis. This positive change will certainly help us to focus on more innovative methods to reach out to people like we did in this crisis i.e. patient consultation without meeting them face to face, knowledge update through webinars, patient educations through podcast. Viewpoints have helped us to make effective treatment decisions in view of limited evidence based data and motivated us to share our learning to rest of the world, to make our view points as a source of learning and important reference for cancer care.

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