Cancer Treatment Delay Due to COVID-19 Infection in Cancer Patients Attended in a Tertiary Hospital of Bangladesh

Abstract

Introduction: The COVID-19 pandemic had a significant impact on health care systems worldwide. However, the brunt of this impact was on the cancer patients getting treatment in specialized oncology hospitals. Objective: to assess the cancer treatment delay due to covid-19 infection in cancer patients attended in a tertiary hospital of Bangladesh. Methods: It was a retrospective observational study and data of all patients dept. of Radiation Oncology, Combined Military Hospital (CMH), Dhaka, Bangladesh from July to December 2020 with cancer or history of cancer with COVID-19 was collected from interview of patient or attendant and medical records in a preformed data collection sheet and then analyzed.  Results: Total 60 patients included were divided into two groups elderly population (>65 year) and younger population, the mean age of patient at diagnosis was 50 years, ranging from 28 to 72 years old, only 10 patients were aged 65 years or more. The most common co morbid condition associated was HTN followed by diabetes mellitus, IHD, bronchial asthma and cerebrovascular accident, patients with multiple co morbidities (26%) were also present in this study. Symptomatic analysis revealed most of the patient diagnosed asymptomatically (32%) and among symptoms fever (28%), shortness of breath (13%) and cough (15%) were the most frequent ones, patients also presented with anosmia, loose motion or altered consciousness. Haematologic and biochemical finding of COVID-19 infected patients shows most of the patients had anaemia (45%) and lymphopaenia (50%) in CBC, hyponatraemia (65%) as electrolyte imbalance and also increased D dimer (85%), raised Ferritin (55%) and high CRP (65%) in biochemical parameter. The most prevailing cancers was breast cancer, Head neck region (larynx, pharynx, oral cavity), Gastrointestinal tract (GIT inc. esophagus, stomach, colorectal) followed by lung, gynecologic, central nervous system (CNS), genitourinary tract, lymphoma and carcinoma unknown primary (CUP). Most of the patients received combined modality treatment including surgery, radiotherapy and chemotherapy. Patients delay in attending oncologist, delay or gap in initiation and continuation of cancer treatment like surgery, radiotherapy or chemotherapy occurred in most of the patients, the average gap of treatment due to COVID-19 infection was 3 months with a minimum gap of 10 days to extending upto 8 months. Conclusion: In conclusion, COVID-19 positivity during the scheduled radiotherapy treatment course chemotherapy and surgery has caused treatment delays. Multiple patient factors, such as race and ethnicity, underlying primary malignant neoplasms, multimorbidity, geographic location, receipt of COVID-19 vaccine, severity of COVID-19, and timing of COVID-19 diagnosis, were associated with delays in cancer treatment.