Impact of the pandemic on cancer care: Lessons learnt from a rural cancer center in the first 3 months

INTRODUCTION

The COVID-19 outbreak and the subsequent declaration of pandemic was an unprecedented event, which created different complex situations for treatment of cancer patients. A critical assessment of the response to this calamity and its impact on healthcare workers (HCWs) and patient care in a dedicated cancer hospital is analyzed.

SITE OF STUDY

Indrayani Cancer Hospital, Alandi, Pune, India.

MATERIALS AND METHODS

Due to the pandemic, standard operating protocols were decided on for each department. Analysis of the impact on healthcare was done by comparing the number of patients taking treatment in the lockdown period in India with the previous year's data in the same corresponding period in all three departments. The impact of COVID infection on the HCW and its repercussions were analyzed.

RESULTS

There was a marked decrease in the total number of patients during the lockdown period. The most affected department was surgical oncology. None of our patients contracted COVID-19, but one HCW was found to be positive.

CONCLUSION

Strict adherence to protocols along with the support of the government authorities can prevent the spread of this virus thus providing optimal patient outcomes. The treatment of patients with cancer should not be delayed, even in times of a pandemic.

Outcomes in Patient Undergoing Maxillectomy for Squamous Cancer Invading Maxilla in a Rural Tertiary Care Institute in Socioeconomic Poor Group of Patients

Background: Oral cancer accounts for more than 250,000 new cases of cancer in India. Oral cancer combining all sites of cancer in oral cavity is the single commonest cancer in males in India. Oral cancer involving upper alveolus and primary maxillary sinus tumors are a surgical challenge due to the complex surgery and rehabilitation. Aim: Optimal treatment strategy for treatment of squamous cancer invading maxillary sinus. Methods: This is a retrospective study of clinicopathological features, treatment, rehabilitation and outcome of all patients who underwent surgical treatment of tumor invading maxillary sinus over a period of 30 months in a rural cancer hospital. Results: Out of a total of 47 patients, 26 (55.3%) were males and 21 (44.7%) were females. Median age was 56 year with youngest patient of 23 year and oldest 88 year old. Primary maxillary sinus cancers were 19.1%, palatal tumors were 10.6% and 70.3% were buccal mucosa and upper alveolus cancers. Early cancers were 51% and locally advanced were 49%. Total maxillectomy was performed in 59.6%, partial maxillectomy in 34.1% and extended maxillectomy in 6.3% of the patients. Histology was squamous carcinoma in all patients and 85.1% were grade 2. Peripheral neural invasion was present in 14.9%, lympho-vascular emboli in 23.4%, and surgical margins were positive in 10% of the patients. Eighty percent patients underwent reconstruction by free microvascular flap. Fifty-one percent patients received postoperative chemoradiotherapy while 25.5% received only radiotherapy and 19.1% received no adjuvant treatment. At a mean follow-up of 11 months 74.5% patients are alive. Good speech was achieved in 70% and intelligible speech in 17% of the patients, while 12.8% were not able to speak. Solid food swallowing was achieved in 36.2%, semisolid in 27.6%, liquid in 19.1% of the patients and 12.8% remained on nasogastric tube feeds. Conclusion: Surgical resection with reconstruction by microvascular flap and postsurgical chemoradiotherapy in locally advanced cancers is key for improved survival and successful rehabilitation in cancer invading maxilla.