How We Treat lung Cancer during SARS-Cov-2 (COVID-19) Pandemic in India?

Humankind is facing a unique challenge to its existence from the COVID-19 pandemic which has engulfed almost the entire globe, with more than 200 countries affected so far. The clear but unforeseen threat of this invisible enemy (SARS-CoV-2) will soon pose a major threat to the global economy, by destabilizing the social balance and health-care system. The motto of human life as of today is to “survive by any means” on this planet and therefore has to be our cumulative and coordinated battle against this invisible enemy. The danger is so frightening that even the very resourceful and powerful countries of the world have started crumbling under the burden of day-to-day increasing number of deaths and lack of adequate health-care resources which are falling short day by day to fight the infection.

Population of every stratum is at risk of being infected. The patients with cancer are more prone to infection during this pandemic.[1],[2] Therefore, the field of oncology is going to be under tremendous stress for dealing with the alarming situation in the coming days.

Lung cancer is the most common cancer worldwide among males and the most common cause of cancer-related mortality as per GLOBOCAN 2018 data.[3] Every year, nearly 70,000 new lung cases are diagnosed in India. Lung cancer patients are at much higher risk of infection as they are already compromised for respiratory reserve due to the disease burden, smoking-related lung injury with coexisting chronic pulmonary disease, treatment (immune check-point or tyrosine kinase inhibitor [TKI])-related lung injury, and on the top of that the SARS-CoV-2 primarily involves the respiratory system. A very early report supports the aforementioned fact that lung cancer patients are at a high chance of getting infected even when not on any active treatment.[1],[4] All oncologists around the globe are making standard operating procedures (SOP) to optimize the cancer treatment during this pandemic with the following aims – (a) To decrease the burden on already overstretched health-care resources by reducing treatment-related toxicities, (b) to weigh the risk against benefit of any oncological intervention in the context of this pandemic for reducing the risk of infection and resultant morbidity-mortality, (c) to decrease the unnecessary footfall in hospital settings for merely follow-up and review of cancer patients who are not on any active treatment and thus reducing community spread of the infection, and (d) to delay or defer any oncological treatment in case of slow-growing disease where immediate treatment is not warranted.

Hence, the basic questions are – (a) Which patients should get immediate treatment?, (b) in which cases can the treatment be delayed or deferred without compromising the oncological outcome?, and (c) which patients should not be offered any active treatment and should remain on best supportive care because social distancing overweighs the risk of getting COVID-19 infection.

We have reviewed the recommendations of NCCN, ASCO, ESMO, and IASLC for systemic therapy; and landmark randomized control trials for guiding systemic therapy in lung cancer patients during this pandemic keeping in mind the risk–benefit ratio of any intervention, logistics of access to care including transport, and the availability of resources.

All lung cancer patients, especially those with localized disease where multidisciplinary management is mandated, should be discussed in multidisciplinary tumor board in which a clinical microbiologist or infectious disease specialist should also preferably be included in the current context.

All medical oncologists adopting the following approach must also use their own judgment on a case-to-case basis and must follow local institutional SOP, if any, in the context of COVID-19 pandemic.

Publikationsverlauf

Eingereicht: 01. April 2020

Angenommen: 08. Mai 2020

Artikel online veröffentlicht:
23. Mai 2021

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