Effect of COVID-19 Pandemic on Gynecological Cancer Radiation During Complete Nationwide Lockdown: Observations and Reflections From Tertiary Care Institute in India

Abstract

\n PURPOSE\n To report real world compliance to radiation in gynecological cancers during the complete lockdown phase of COVID 19 pandemic.\n \n METHODS\n From 23rd March, 2020 until 30th June, 2020 complete lockdown was imposed in India. During this period there was restructuring of cancer care and radiation oncology department due to operational policies prevalent in the institution, and the care for gynaecological cancer was based on the evolving international recommendations. Institutional review board approval was obtained to audit patterns of care during complete lockdown phase. Descriptive variables were used to report on patient characteristics, compliance, delays, toxicity and observed deviations in recommended care.\n \n RESULT\n During the lockdown period spanning 100 days, treatment of 270 and telephonic follow-up of 1103 gyneconcological cancer patients was undertaken. Of 270 new patients, due to travel restrictions, 90 patients were referred to the facilities in vicinity of their residence. Of the remaining 180 patients, 138 were planned for complete treatment at our institution and 42 were referred to our centre for brachytherapy. Of 138 patients, only 106 (76%) completed the planned external radiation. Twenty four (26%), patients completed full course of concurrent chemotherapy, 11 (12%) received chemotherapy dose reduction and 57 (62%) received no concurrent chemotherapy. Treatment delay of upto 3 weeks noted in 8.6% patients due to COVID infection. No grade IV-V acute sequelae were observed. No excess adverse effects were observed in high risk population. Low rate of symptom burden was observed amongst 1103 patients on telephonic follow-up. with 100 (9.6%) patients reporting symptoms Amongst these, (54/100) 54% had complete resolution of symptoms within 4 weeks of teleconsultation, while 10% had disease progression.\n \n CONCLUSION\n Low compliance to planned treatment was observed for radiation and concurrent chemotherapy due to lockdown and fear of contracting COVID, will likely lead to increased risk of cancer related mortality. Rapid restructuring of care is needed to prevent the same as COVID pandemic further evolves.\n \n Summary\n The current article provides a real world audit of treatment for gynecological cancers during the complete lockdown phase of COVID Pandemic within tertiary cancer centre in India. Unacceptable treatment delays were noted within the health care system primarily due to societal restrictions posed due to lockdown. No untoward adverse effects were noted as a direct result of COVID infection. Treatment was overall well tolerated by patients\n