Deep Kumar, a senior citizen and a cancer patient based in Faridabad, had been going for his chemotherapy sessions on a regular basis before the lockdown was announced. While Kumar was determined in his fight against cancer his plans took a tumultuous turn when the treatment came to a halt.

The sudden turn of events instilled a sense of fear and he ended up being diagnosed with depression. He consulted a psychiatrist but obtaining the medication suggested by his psychiatrist was also an onerous task because of limited availability. When his daughter, who is based in Delhi, finally found them the medicines, precious time was wasted in trying to get these through the sealed borders.

Deep, is one among several cancer battling patients,struggling to survive the Covid-19 lockdown. As per data by Indian Council of Medical Research (ICMR)[1], in the period of lockdown 3,00,000 new cancer cases would have been diagnosed on an average, but this was not possible because of the restrictive measures. In a country like India, where 60- 70 per cent cancer cases are anyway diagnosed in later stages, this impact of the lockdown will be harsh.

The government’s measures have resulted in limited access to proper medical care for cancer patients undergoing treatment. Chemotherapy sessions, scans, transplants and surgeries have been kept on hold thus exposing cancer patients to higher risks.

According to Dr. Abhishekh Shankar, Assistant Professor, Radiation Oncology at Lady Hardinge Medical College in Delhi, only 30% of cancer patients come from urban areas. The remaining 70% have to travel for their treatment - which they have been unable to do because of the lockdown. A similar dip is reflected in private hospitals which are struggling because of the high burden on healthcare workers. Hospitals, as a precautionary step, are curtailing their healthcare force. Many hospitals are working at 30-40% capacity, with staff coming in shifts, to minimise the risk of COVID-19 transmission. Limited availability of human resources again is posing a huge challenge.

Arun Gupta, a cancer patient himself and founder of NGO Win Over Cancer, said that the immunity of patients undergoing chemotherapy is compromised, their body is weak and they already face a lot of issues. Chemo itself has a lot of side-effects and if a patient gets infected with COVID-19, it can be a life threatening condition.

Similarly for radiation therapy, where patients have to come 5-6 times a week for 7-12 weeks, depending upon the cancer, and this movement itself exposes them to the coronavirus.

Therefore, even if the patient can access medical facilities physically, they are not able to literally. On one hand, cancer patients are scared of contacting the virus in hospitals, so they forgo their treatments, on the other hand, hospitals have been forced to cancel appointments, as a majority of their healthcare staff has shifted to other wards to assist in COVID-19 emergencies.

Supply chain has also been disrupted due to the lockdown. Certain medicines are not able to reach the hospitals, making the institutions helpless and eventually delaying the treatment.

As per guidelines issued by Ministry of Health and Family Welfare and AIIMS Delhi, all non- essential elective procedures/surgeries are to be postponed and only emergency/life-saving surgeries may be taken up in various operation theatres. As a result of this guideline, surgery count has been reduced to below 10% . This is turning out to be highly counterproductive.

Shivam Vatsal, an onco-surgeon, pointed out that surgery is the most critical part.“A patient came to me just 2-3 days prior to lockdown was announced. Being an elderly patient, I recommended him to come after 15-20 days. Neither did I, nor did the caregiver, wanted to take any risk. As the lockdown happened and its first phase was over, the patient came with the disease that had spread so extensively, that surgery was no more an option now. The patient is now undergoing chemotherapy. Such incidents can be seen. Before the lockdown, patients were operable, especially the ones who came at stage 1 or stage 2 of the disease, but after the lockdown, disease might have progressed so that surgery might not be an option anymore. This will impact the outcome of their treatment significantly. Had their treatment started yet, they might have been cured till now, but now their disease might become metastatic.”

A lot of patients have comorbidities, i.e. they are additionally suffering from other serious conditions like diabetes or hypertension. Due to the lack of treatment, their condition is deteriorating even further. Rahul Bhargava, a haemato-oncologist, said that it was ironical that while cancer had not stopped, its treatments has come to a halt. “The reparations would definitely be negative, but no one can really measure the outcome,” he said.

Cancer survivors stand at a higher risk of being affected by the virus in comparison to healthy people. This is pertinent in cancer survivors having other comorbidities like diabetes and hypertension which makes them more vulnerable to the infection. All these factors accumulate and add to the psychological distress of the patients and survivors.

Lifting of lockdown will not ease things for cancer patients. Due to the delays in their treatment and follow-up appointments, once the lockdown is over, overcrowding at hospitals is expected. Hospitals and healthcare workers need to prepare themselves in advance for the surge in visits. Making provisions for systematic social distancing, making arrangements to make masks mandatory, working for extra hours and ensuring minimum risk of transmission of COVID- 19 in hospitals are a few measures which the hospitals need to take.

The lack of funds for treatment of patients has added to their pile of woes. Since all the funds are being diverted to tackle COVID-19, provision of support to under-privileged cancer patients via funding through social schemes, corporate social responsibility and not-for-profits seem to be difficult in the future. Hence, making the treatment unaffordable for many and leaving them in a conundrum is like a ticking time bomb, which will explode, once the lockdown is lifted completely. The impact of this is already being felt, and time will determine its severity.