According to COVID-19 notes from the Tata Memorial Centre in Mumbai, published on 28 April 2020 in The New England Journal of Medicine, de-escalation of services has been less pronounced than the cuts made at similar cancer facilities globally.
The authors from the Tata Memorial Centre, the oldest and the largest comprehensive cancer centre in India, wrote in their report that their previous work on the “Choosing Wisely India” campaign outlining practices of low value or that could be even harmful in cancer care, facilitated their response to COVID-19 situation. In particular, the authors emphasised that countries with no high rates of death from COVID-19 could consider approaches that involve balancing pandemic control with providing continued cancer care.
In the note, the authors wrote that some cancer centres reduced significantly their services after preliminary reports from China which showed that COVID-19-related outcomes are significantly worse among patients with cancer. In addition, issues were reported in placing a strategy ahead while relying on inadequate information and on models of disease spread which were based on assumptions.
At Tata Memorial Centre, it was decided to continue with providing cancer care despite reducing services by about one third. Certain degree of reduced operations was needed to allow for physical distancing and because lockdown in India prevented some patients and healthcare workers to reach the hospital. However, reduction in services was less pronounced than the cuts made in similar cancer centres globally because the virus has spread more slowly in India than in some other countries and they didn’t have large numbers of hospitalisations for COVID-19.
At Tata Memorial Centre, the healthcare workers see more than 70,000 new cancer patients annually. A slowdown in providing clinical services is likely to have an impact on outcomes. The authors warn that although cancer is frequently not immediately a life threatening disease, delay in cancer care can have serious consequences. They described a process of making some difficult choices, including prioritisation criteria to guide treatment decisions.
In another article published in the Indian Journal of Cancer, the Tata Memorial Centre staff described some unconventional solutions implemented to manage the problems they faced in order to provide continuum of cancer care. They started a number of staff buses to transport staff to the hospital, taking care about bus routes planning, shifts, keeping transport times acceptable and providing employees pick-up and drop points as close to their homes as possible. The number of buses and the routes were modified on a day to day basis. They also tied up with the government-run transport corporation to provide additional bus routes which could be used both by staff and the patients.
Some of healthcare staff were warned by their housing societies that they would not be allowed to go to hospital and return to their homes for fear of bringing back the infection. Therefore, the hospital advocated with the Mumbai police to issue a warning with penal action for housing societies in such cases.
Hospital also helped some patients from Mumbai to reach their home by using hospital vehicles and those provided by some non-governmental organisations. However, it was still not optimal to manage the multiple locations of inpatients at the hospital. Furthermore, patients who could otherwise be discharged continued to remain in hospital because they had no place to stay outside. Hospital reorganised some clinical wards by consolidating patients on active treatment into fewer wards and used the emptied wards as a hospital hotel. They also created temporary accommodation facilities including some inpatient wards for some hospital employees.
Along with implementation of interventions, staff in Tata Memorial Centre realised that many other hospitals faced with similar challenges and that would benefit from sharing experiences through a series of webinars started weekly.
- Pramesh CS, Badwe, RA. Cancer Management in India during Covid-19. NEJM; Published online 28 April 2020. DOI: 10.1056/NEJMc2011595
- The COVID-19 pandemic and the Tata Memorial Centre response. Indian Journal of Cancer. DOI: 10.4103/ijc.IJC_250_20