The COVID-19 pandemic, detected first in December 2019, has led to four lakh deaths and close to 12 million being infected. It has led to disruption in mobility and access to healthcare due to measures such as social distancing and lockdown. Due to the infection, patients had difficulty to access transport facilities, interstate travel and obtaining permissions from authorities. All these factors led them not to adhere to their fixed appointments leading to an impact on outcome. Hence, with a collaborative effort from Oncologists and nursing staff, we explored the impact of COVID-19 and the lockdown on adherence to treatment among Cancer patients.
From April 1 to June 30, 2020, patient information was collected at the Day Care Unit, in the Department of Medical Oncology and Haematology at the American Oncology Institute, Serilingampally, Hyderabad, India. Patients with delay in treatment for more than 7 days were identified and followed up. Length of delay of treatment was recorded. All patients gave their informed consent for the study.
A total of 737 patients underwent treatment. Number of patients who received treatment as per schedule were 656 (89%). Eighty-one patients out of a total of 737 (11%) during the 3-month COVID-19 period had treatment delays. Of these most treatment delays were due to fear of COVID infection (50.6%), followed by medical delays (26%) and transport and travel issues (23.4%). Impact of COVID per se on treatment delays was as low as 8%. A delay of 3- 7 days is usually acceptable for re initiating chemotherapy, to allow clinical and count recovery. Any delay beyond 7 days was considered nonadherence to treatment schedule. Most delays were shorter, less than 14 days (68%). Most of the delays were in the elderly age group (more than 50 years). Among patients missing their schedule, those more than 50 years and less than 50 years were 75 and 6 patients respectively. This was assessed in view of the increased mortality due to COVID in elderly patients.
Despite the pandemic and subsequent nationwide lockdown, treatment nonadherence due to COVID-19 was low, short and mostly seen in the elderly group. Cancer patients tend to continue treatment despite the COVID crises, and this requires validation in a longitudinal cohort.
The authors.
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All authors have declared no conflicts of interest.