How do you fight when cancer, COVID-19 collide?

In past six months, Tata Memorial doctors collective energies have been focussed on three isolation centres where cancer patients fight a dual battle

In the over six months since COVID-19 hit Mumbai, the ride has certainly not been a smooth one for anyone. For patients and doctors already battling cancer, the fight for survival achieved a host of new dimensions. Armed with its expertise, the Tata Memorial Hospital (TMH) in Parel became the obvious choice to fight the two Cs. TMH's doctors have been managing three isolation centres where 1,080 COVID cancer patients have been treated in the pandemic.

TMH came across its first COVID-19 cancer patient towards the end of March. Dr Rajendra Badwe, director, Tata Memorial Centre said that the hospital stepped in to treat all COVID cancer patients and set up an isolation centre at the hospital, one at NSCI Dome (with 70 isolation beds) and another at the Advanced Centre for Treatment, Research and Education in Cancer (ACTREC) with 24 beds each for isolation and quarantine. Two floors at TMH have been converted into isolation wings with 90 beds, and one floor has been set aside for quarantine.

People wait in the reception area of the hospital

The TMH was converted into a fortress to enable treatment of both COVID and non-COVID cancer patients. "Suspected cases were moved to the COVID area and tested while the rest took precautions like masks, sanitisers and social distancing. We will continue this until things are on the wane," said Dr Badwe, adding that the staff at the hospital was also reduced to half. The other half worked from home on video and phone follow-ups with patients.

The initial months of the lockdown saw a significant decrease in patients as all travel shut down. Dr C S Pramesh, director, TMH said, "During April and May, we saw only 45 per cent of the patients (60-70). We organised 66 buses (BEST and private) to ferry patients and staff." The numbers are rising again and between August and September, the hospital got 150 new patients daily. Of these, 10-12 have COVID. Before COVID, TMH would get over 200 patients a day.

Dr C S Pramesh, director, Tata Memorial Hospital

A variety of challenges

Over the past six months, certain trends have naturally been noticed among COVID cancer patients. Dr Pramesh pointed out that the mortality rate of such patients in some western countries is close to 20 per cent and the normal average is around 2 per cent. At TMH, it is 11 per cent, especially among those with co-morbidities. "The outcome is worse for those with blood cancers like leukaemia and lymphoma than those with breast or stomach cancer. World over, the outcomes of COVID cancer patients is worse than for those without cancer," he said.

Doctors had to face a variety of challenges, particularly in the head and neck oncology department. Dr Pankaj Chaturvedi, head and neck cancer surgeon at TMH, said, "Cancer care must go on since it is a certain killer if people are not treated on time while COVID kills around 4 per cent of the infected. In cases of head and neck cancers, we have to take the utmost precautions as we examine the oral cavity and look into the throat. COVID spreads through the mouth and nose and a cough or a gag generates aerosols," he said.

Dr Rajendra Badwe, director, Tata Memorial

Apart from hand hygiene, precautions include keeping the doors of the OPD open to avoid re-circulation of air.

Dr Chaturvedi has also been overseeing the treatment of COVID cancer patients at NSCI and has so far treated over 500 patients and their relatives.

A different fight for children

The fight has brought valuable lessons too. Dr Girish Chinnaswamy, head of the paediatric oncology department said that initially, they tried to postpone chemotherapy until the patient was COVID free. However, later they realised that the treatment can continue in isolation. "In children, cancer is aggressive but also highly curable. With a four to six week gap in treatment, the cancer would progress. Till date, we have treated 140 children with cancer and COVID; four of them didn't make it," he said. In children too, those with blood cancers suffer more. Dr Chinnaswamy said, "Among the child COVID cancer patients, 90 have leukaemia and lymphoma and 50 solid tumours. Of the four who died, two were terminal and two had blood cancer. Leukaemia involves six months of daily intensive therapy which suppresses the immune system the most, and hence the viral load multiplies quickly," he said.

Many hurdles

The past six months haven't been easy and despite all precautions, around 450 doctors and staff members got COVID while on duty. The hospital still has some hurdles to cross, the biggest being a steady blood supply, especially for surgeries. With the pandemic having affected blood donation drives and people reluctant to visit hospitals for donation, THM organised camps at residential societies. "We are still finding it difficult to find blood donors. We need at least 30-35 per cent, which is around 150-200 donors per week, more than the current supply," said Dr Pramesh.

Given the expenses for PPE kits, masks and ventilators, the hospital authorities said that funds have been diverted for COVID treatment. "We received some funds from the government, donations and CSR and we purchased equipment for COVID treatment. But we could do with more support through philanthropy for patient care and equipment for cancer patients," Dr Pramesh said.

The hospital received support from the Tata Trusts as well, which provided rooms for quarantined patients at two branches of Ginger Hotels and Taj Lands End. A portion of the hostels at the Bhabha Atomic Research Centre was also converted into quarantine facilities.

Patients' ordeals

A 13-year-old boy from Uttar Pradesh was in the middle of treatment when the pandemic hit. While the hospital had arranged for accommodation for the child and his parents, during the early months of the lockdown, they could not go anywhere except to the hospital.

"We were terrified that our son would get COVID or that he would get it from one of us. So we stayed indoors. After his treatment finished in June, we wanted to go home where it was safer but there was no way," the boy's father said. They tried to find a rental car or a bus but to no avail. The family was stuck in the city for a month and a half until TMH authorities found them a place on a train. They were among the families of 203 such patients who returned home on the train.

150
Approx. no. of new cancer patients daily

12
Approx. no. of cancer patients with COVID

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