by Akhter Hussain Bhat & Dr. Mohammad Akram

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As of September 08, 2021, according to WHO, the COVID-19 pandemic has affected 222 countries and territories, with more than 220 million cases and 4.59 million deaths. The COVID-19 pandemic has resulted in widespread mortality and has exposed the weaknesses of health-care systems worldwide. National responses to the pandemic have varied from country to country, with restrictions or lockdowns of varying severity implemented. There are concerns that several areas of health care, such as infant and maternal health, immunization, and non-communicable diseases could be adversely affected by the pandemic. The reasons for these adverse consequences are multifactorial like health systems have been overwhelmed due to the prioritization of COVID-19 treatment over other diseases and the fear of the virus transmission both among the general public and health-care providers.

In response to the pandemic, the Government of India announced a complete nationwide lockdown on March 24, 2020 to prevent the spread of the virus resulting in a lot of unprecedented events. The National Health Mission reported a 69% reduction in measles, mumps, and rubella vaccination in children; a 21% reduction in institutional deliveries; a 50% reduction in clinic attendance for acute cardiac events; and a surprising 32% decrease in inpatient care for pulmonary conditions in March 2020 compared to March 2019. Under these circumstances cancer care wasn’t far behind. Nearly 70 percent of patients could not access life-saving surgeries and treatment. Chemotherapy treatments and follow-ups were postponed. Even private clinics in major Indian cities reported a nearly 50 percent decrease in patient footfall for cancer from the numbers they saw earlier. Overall cancer services declined by 50 percent in April and May 2020, as compared with the same period the year before. Failing to attend regular cancer care follow-up, not being able to attend the scheduled emergency surgeries, and not being able to reach home after chemotherapy were some of the common problems that resulted in the loss of life in certain cases (Chopra et al, 2020).

Some cancer centers were partially or completely converted to COVID-19 treatment facilities. Data from cancer centers across the world have shown that the provision of oncology services has been considerably reduced during the COVID pandemic. Projections from many countries indicate increases in mortality in the next 5–10 years due to delays in diagnosis for several different cancer types. Globally and in India, real-world data about the true impact of the pandemic on cancer services at a national level is scarce. We aimed to assess the impact of the COVID-19 on the provision of cancer care in Kashmir, a cancer belt of India having a peculiar cancer profile which is no exception to the devastating impacts of the pandemic.

The Kashmir valley located at a very high altitude with a majority of Muslim population possesses unique culture from the rest of the country. Over the past decade, a significant increase in the number of cancer cases has been reported in Kashmir valley. As per the surveys conducted in Kashmir, it has been shown that among the various cancers, gastric cancer is one of the most common cancers with about 18.8% prevalence, followed by colorectal cancer 16.40%, female breast cancer 16.10%, lung cancer 13.20%, and head & neck cancer 10.80%. The incidence of various cancers differs across the all districts in Union territory of Jammu and Kashmir with maximum number of cancer patients belonging to the district Srinagar (898; 14.11%), followed by Jammu (853; 13.4%), Baramulla (573; 9.0%), Anantnag (489; 7.7%) and Budgam (452; 7.1%). According to Union Health Ministry’s figures, an estimated 39041 cancer cases were recorded in between 2019 to 2021 of which 12675 were recorded in 2019, 13012 in 2020 and 13354 in 2021.

The covid-19 pandemic has placed an enormous strain on patients with cancer around the globe. The cancer patients refrain from visiting hospitals for fear of being affected by the covid-19 virus. In addition hospitals and medical centers have also been flooded with coronavirus patients which then leaves those in need of other forms of medical care on the back burner. Amid the covid-19 pandemic threat, panic, phobia, lockdown, and what not, the cancer burden continued to grow, thus exerting tremendous physical, emotional, and financial strain on individuals, families, communities and health systems. The war against corona was declared in March, 2020 in UT of J&K when the education system, the internet, tourism, travel, trade, offices got shut, roads were deserted, law and order crises and the corona was everywhere, contact tracing, tracking testing, assault on health care personnel, panic everywhere, even the hospital phobia was the routine of the day. Due to the measures adopted by the UT government to prevent the spread of the infection, cancer patients face major encounters. Here some of such encounters can be talked about in order to reflect on the impact of the COVID pandemic on the cancer and its management in Kashmir taken from different online web portals.

Ghulam Nabi Bhat, a 74-year-old cancer patient found himself caught between a rock and a hard place in the face of the recurrent COVID lockdowns. Hailing from the Sanat Nagar locality in Srinagar, Bhat suffers from stage two multiple myeloma, a type of cancer that causes cells to accumulate in the bone marrow, where they crowd out healthy blood cells. “We could ill-afford to wait out a crisis of this length at home or rely on telemedicine alone. So instead of seeking treatment from Regional Cancer Centre SKIMS, he now receives his weekly chemotherapy cycles from a private hospital,” his son is reported to have said. Several cancer patients in Kashmir remain apprehensive as their life hangs in balance due to coronavirus. On the one hand, they are at risk of developing severe complications from Covid-19 because of their low immunity, and on the other delaying the treatment can have dire consequences. Lone Mohammad Maqbool, professor and head department of radiation oncology, SKIMS says that due to the pandemic risk the patient inflow has decreased considerably. “On average, if there were 100 patients, only 60 percent come for the treatment. One of the reasons for this decrease is also because the follow-up cases are given medical advice over the phone”, Lone is reported as saying. He further apprehended that the patients who were in early stages of the terminal illness two months ago might have now progressed to the later stages with a reduced chance of recovery. This stems from the fact that many fresh cases updated at the registration counter on a normal day would be around 10-15. It has come down to 7-8. It indicates that there are some patients who are reluctant to avail treatment from the hospitals which increases the further complication of the illness.

The fear of getting infected of the virus created further vulnerabilities to the already suffering cancer patients. Unmarried Shabnum, 29, a resident of south Kashmir and a cancer patient registered with RCC, SKIMS had her chemo session due in early April 2020. Owing to the virus scare, she skipped the hospital for the treatment. Shabnum was under the impression that the entire SKIMS stands converted into a Covid-19 facility. It was after her treating doctors gave her details that she reluctantly decided to visit. “It was not only me who was at risk but my parents who accompanied me to the hospital were also at risk. ‘And then this is an ongoing treatment where a patient has to come to hospital regularly for a week or 10 days till the session of doses completes. I do not want to add another vulnerability to my aged parents” Shabnum is reported to have said. In another case Tasaduq Hussain, a banker by profession and a resident of Srinagar’s uptown locality, was making vacation plans for the next year. With family consultations, he finalized a fortnight-long vacation. Subsequently, he booked flight tickets for the first week of January 2021 to multiple cities. But before the family could take-off Tasaduq complained of Hematuria, the presence of blood in the urine. After several consultations and investigations, he was diagnosed to have malignant cells in a part of his urinary bladder. Shattered, the plan changed and the new priority was to save a life. As advised by the doctors, he was immediately operated. Post-surgery, he was put on regular follow-ups for chemotherapy for the next couple of months.

However, in between another crisis erupted. His repeated testing date collapsed with the onslaught of Covid-19. Caught between Covid and compulsory testing, Hussain was feeling restless. He was having sleepless nights when district administration in Srinagar decided to impose a complete lockdown to control the contagion spread. As life came to a standstill, Husain became skeptical of his survival. Shuttling between the hospital, diagnostic laboratories and private clinics to analyze post-surgery status, he had to hear a piece of distressing news. “All my tests were clear but the CT showed one more spot where the doctors analyzed that it could be a renewed growth. So every day my destination was SKIMS hospital to private clinics to know what it is, which was followed by tests”, Hussain is reported to have said. Not willing to take a chance, the doctors treating Hussain suggested another surgery for mass removal. This time it was a more difficult decision for the family than the previous one. “The coronavirus had reshaped the world. When people were running away from the hospitals, I had to decide to go to one. It was like a double edged sword. If I didn’t go for the procedure, I could have died. And if I opted for it, Covid-19 would have killed me. But then after taking all the precautions, I decided to go for the surgery for my lone daughter, who is just 10 years old”, reports Bhat as saying Tasaduq.

Finally, the second surgery was done in mid-April. However, Hussain was attended by his wife only. People were avoiding hospitals as they were converted into Covid care centers. Before the couple could meet their daughter, they had to go for mandatory quarantine for 14 days at home. The isolation led to further stress, but the quarantine days passed peacefully without any symptom and negative for the virus, the routine was resumed with new chemotherapies. Recalling, Tasaduq is reported to have said that it was a do or die situation for us. “I had to go on a weekly basis and every time I was in the hospital, I used to avoid any contact. There was not an option to skip. We could not afford to miss our doses”, reports Bhat. Once done with the doses the trauma to stay alone started again. Finally, fighting for survival, it was after six months, Hussain and his wife could see their only daughter who was shifted to her grandparent’s house due to virus fear. These and the like events are the sheer reflection of the repercussions of the Covid-19 pandemic on the illness and treatment of the already immune compromised cancer patients in the Kashmir valley.

Besides the pandemic leading to further surge of cancer incidence and mortality in Kashmir like other parts of the country, there is an increasing risk of cancer mortality rate among Kashmiri population and it is attributed to some of the leading behavioral and dietary habits like high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, stress and lack of regular check-up. Evidence reveals that the changing lifestyles and food habits among the people has caused a surge in all cancers especially in Lung, GIT and blood cancers. Due to increasing smoking rates in children and young adults, the incidence of lung cancer is witnessing sharp increase with every passing day. There is no denying the fact that the coronavirus pandemic is potentially one of the worst public health crises the human beings have ever experienced. This crisis has brought unprecedented challenges before world governments. But a crisis is no excuse to focus all of one’s efforts on one disease at the expense of others. Considering the serious medical and emotional needs of patients, the governments need to issue scientifically drafted patient centric guidelines about managing cancer patients and handling their care against the backdrop of the COVID-19 outbreak. Health care providers on their part must remain committed to providing cancer patients the information about the appropriate medical care, practice modifications and treatment plans. The COVID-19 needs to be managed, but not at the expense of lives and sufferings of cancer patients. Cancer like coronavirus does not respect national borders, neither should we.

 References:

Azmat, H (2020). Low immunity, Lockdown Blues Kashmir Cancer Patients Lives Hang in Balance: Retrieved: https://www.thekashmirmonitor.net/low-immunity-lockdown-blues-kashmir-cancer-patients-lives-hang-in-balance/

Bhat, S (2020). Cancer’s Covid-19 Overlap. Retrieved: https://kashmirlife.net/cancers-covid-19-overlap-issue-35-vol-12-253339/

Bhat, AH., Akram, M (2020). Cancer Care During Covid-19 Pandemic: Untold Challenges. Retrieved: https://countercurrents.org/2020/05/cancer-care-during-covid-19-pandemic-untold-challenges/

Chopra et al, (2020). Impact of Covid-19 on Cancer Care in India. Retrieved: https://ascopost.com/issues/november-25-2020/impact-of-covid-19-on-cancer-care-in-india/

Greater Kashmir Aug 3, 2021.  JK reports 39000 cancer cases in 3 years. Retrieved: https://www.greaterkashmir.com/todays-paper/jk-reports-39000-cancer-cases-in-3-years

Khan, N (2021). World cancer day amid Covid-19 Pandemic. Retrieved: https://www.greaterkashmir.com/todays-paper/world-cancer-day-amid-covid-19-pandemic

Qayoom H, Bhat BA, U Mehraj U, Mir MA (2020) Rising trends of Cancers in Kashmir valley: Distribution Pattern, Incidence and Causes. J Oncol Res Treat 5: 150.

Qurieshi Mariya A, S.M.Salim khan, Masoodi A Muneer, Qureshi Uruj, Quratul Ain, et al. (2016) Epidemiology of cancers in kashmir, India: Adv Prev Med 1-6.

Sahoo SS VM, Parija PP (2018) An overview of cancer registration in India: Present status and future challenges. Oncol J India 2(4):86.

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Jammu_and_Kashmir

Authors:

Akhter Hussain Bhat is Ph.D. research scholar at department of sociology, Aligarh Muslim University, Aligarh. The author can be mailed at: hussainakhter078@gmail.com

Dr. Mohammad Akram is professor of Sociology at department of sociology, Aligarh Muslim University, Aligarh, India. Prof. Akram has five published books and several research papers to his credit. He has specialization in sociology of health, migration, work, education and social policies. He has been engaged in the profession of teaching, research and supervision for more than twenty years. He is an elected member of the managing committee of India Sociological Society (ISS). He can be emailed at: akram_soc@yahoo.co.in


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