Gallbladder Cancer: Adjuvant and Palliative Treatment during Covid-19 Pandemic in India

Introduction

The Covid-19 pandemic does not require any formal introduction. We are going through a unique situation wherein the health-care system is at an unprecedented risk. In times of war and natural calamities such as earthquakes and floods, health-care workers continue to do their job, but the irony here is health-care workers themselves are at risk. This pandemic has created a challenge of epic proportions regarding the management of one of the most vulnerable groups of patients who have cancer. We are dealing with an overburdened health-care system, reduced availability of resources, and health-care personnel. The question that arises here is “Who bells the cat?” With this rapidly growing pandemic, it is understood that risk–benefit ratios of formerly well-established interventions will change drastically.

Gallbladder cancer (GBC) is one of the most common malignancies in North India. In the Delhi Cancer Registry, it is the third-most common cancer in females. The majority of patients present in an advanced stage and the disease carries a dismal prognosis: the median survival is around 6 months, and 5-year survival was reported to be <5%.[1], [2] The limited benefit of aggressive treatments needs to be rebalanced in the scenario of the ongoing pandemic. A small study suggested that cancer patients with Covid-19 infection undergoing active treatment have a higher morbidity and mortality.[3] Further, frequent hospital visits for intravenous (IV) chemotherapy/radiotherapy are expected to overburden an already-burdened health-care system and expose patients to hospital-acquired Covid-19 infection. The members of the Science and Cost Cancer Consortium, New Delhi, have therefore formulated guidelines in these difficult times. The intent of these guidelines is to find a best middle ground for the benefit of patients, their families, their oncologists, and the health system. The guidelines are aimed to effectively use the existing infrastructure, maximally prevent the Covid-19 infection and its complications by using easily manageable chemotherapy, and reduce hospital visits as far as possible. It is emphasized that these guidelines are for use during the ongoing pandemic only. Due to the absence of specific data in a pandemic setting, the level of evidence for these recommendations is C (Expert consensus).

Publication History

Received: 28 March 2020

Accepted: 09 April 2020

Article published online:
23 May 2021

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