Impact of COVID-19 on Cancer Care in India

Background: The COVID-19 pandemic has disrupted healthcare systems leading to concerns about its impact on non-COVID disease conditions. The diagnosis and management of cancer is time-sensitive and is likely to be substantially affected by these disruptions. We conducted a study to examine the impact of COVID-19 on cancer care in India. Methods: We conducted the study in member institutions of the National Cancer Grid of India to compare provision of oncology services during the months of March to May 2020 with corresponding months in 2019. We collected data related to cancer diagnosis and treatment, screening, research and educational activities. We calculated proportional reductions in 2020 compared to 2019. Findings: We collated data from 41 centres across India including public, private and charitable institutes, with a total annual patient load corresponding to 33.9% of India’s overall cancer burden. We found substantial reductions in almost all metrics studied. These included (proportional reductions within brackets) number of new patients registered (54%), follow-up visits (46%), hospital admissions (36%), daycare chemotherapy (37%), operations performed (minor, 49%; major 52%), patients accessing radiation treatments (23%), diagnostic tests conducted (pathology, 38%; imaging, 43%), and palliative care referrals (29%). These reductions were even more marked in April and May 2020. Cancer screening was negligible at more than 70% of centres during these months. Reductions were more marked for centres in Tier 1 (larger) cities compared to those in Tier 2 and 3 (smaller) cities. Interpretation: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. Funding Statement: There were no funding sources related to this study. Declaration of Interests: None to declare. Ethics Approval Statement: This study was exempt from Ethics Committee approval