Everything on Cancer Care Amid COVID-19 With Cancer Expert Dr. Abhishek Shankar

Dr. Abhishek Shankar, MD is an Assistant Professor in the Radiation Oncology Department at Lady Hardinge Medical College and Associated Hospitals, Delhi. He has worked in various capacities i.e. Resident, Research Fellow, and Faculty at All India Institute of Medical Sciences, Delhi from 2012-2019. He is an NCI Cancer Prevention Fellow and the recipient of numerous national and international awards. He is a member and chairman of several national and international committees.

In this recent interview with NewsGram, he has answered all the questions regarding cancer and cancer care at a time when many oncologists and cancer patients are worried about the emerging challenges to cancer care delivery in the wake of the ongoing COVID-19 pandemic!

Kashish: Despite a lot of awareness on cancer, many people are still not aware of its treatment and consequences. What do you want to say about this? How well India is prepared to fight cancer?

Dr. Abhishek: Well, I would like to say "awareness" is a very broad term. Hearing the word "cancer" doesn't makes you aware of the disease. So, there are many components of cancer like signs and symptoms of cancer, risk factors for cancer, what you need to do if you are having a symptom related to some particular cancer, etc. So, people are aware but this awareness is limited to the metropolitan cities where they are more exposed to information on cancer provided by the print media or electronic media. People might have good knowledge about cancer, they might have a positive attitude but the practice is required to detect cancer at earlier stages. To put the provided information into action for cancer prevention is missing in every part of the country, whether it is a metropolitan city or the rural parts of the country. Just having "knowledge" about something does not prove to be useful unless and until it is applied into practice.

I feel that the awareness is scattered. Now cancer has reached most of the families in every society, so many people feel connected whenever it comes to the disease but that is not to be termed as awareness. It becomes very essential for me to differentiate "awareness" from "pseudo-awareness". Probably people have more awareness of cancer by reading on the internet, so the outflow of the right information is very much important.

People have this belief that drinking tea in a plastic cup causes cancer, but at the same time, they are ignoring the fact that smoking causes cancer. They can smoke 14 cigarettes a day, but they will complain to a tea seller that they don't want their tea to be served in a plastic cup because it causes cancer! So this is pseudo-awareness. People these days are getting more rumored information from WhatsApp and Facebook University which is very dangerous. We need to focus on the right information and cigarette smoking is the definite cause of cancer but drinking tea in a plastic cup is not actually a risk factor for cancer, it may have some effects but it is not proven.

The right focus for taking the right action for cancer prevention is very important, and you will only be able to focus rightly only if you know the right information and this is missing in our country. Cancer has become a public health problem. Almost 10 billion people are dying because of cancer globally. There's a need for people to become aware of cancer because as soon as they encounter a cancer symptom, they can rush to a doctor and seek timely medical support.

Many people avoid doing marriage in a family where somebody is suffering from cancer, so, there's a strong need for us to work on awareness so as to understand what is right, wrong or a myth. In a resourceful country like India, people should be made aware in order to minimize the mortality rate related to cancer.

Kashish: We are still amid these unprecedented times of COVID so what, especially, do you want to tell cancer patients/caregivers about COVID-19?

Dr. Abhishek: Well, in 2020 March, this was a very impatient question for an oncologist and nobody was knowing the answer, interestingly! It was the situation in which everybody was in dilemma regarding what to offer, what not to do etc. Initially, it was said that cancer patients are more at risk to get infected with the coronavirus, and if they got so, their chances of mortality from COVID will be more as compared to the other people.

Over the period of time, we have managed well. In the era of evidence-based medicine, we probably relied on personal testimony, viewpoints, personal experiences which never happened in the history of cancer treatment.

Over a period of time, everything has been streamlined. Cancer patients are guided to continue their treatment the way it was because apparently, we have to make a balance. In the initial period of time, we were having this dilemma that why do we have a need to expose them? but still, they are encouraged not to visit their cancer center unless not necessary. Now, every guideline says that you don't have a need to halt your cancer treatment, you must continue it. We know now that this pandemic is more than one year old and we don't know when will this end. So, now, we have adjusted because we realized that cancer patients get only one chance to get cured and hence we need to continue with the treatment as any gap in the treatment over the period of time will affect the final outcome for a cancer patient. We have changed our day-to-day working in the best interest of the patient.

There are a lot of precautions that the cancer patients/ caregivers must follow such as maintaining hand hygiene and respiratory hygiene. We keep on instructing our patients about the follow-up guidelines. They have to adhere to that. In many hospitals abroad, they have prepared COVID-dedicated cancer hospitals. Even if the cancer patient is COVID positive, there's no need for him/her to avoid treatment.

Kashish: So does survival with cancer make a person more prone to getting infected with COVID-19?

Dr. Abhishek: See, cancer patients undergo immunotherapies and chemotherapies which makes the immune system weak. In general, cancer disease cause some level of immuno-suppression to the patient. So, it is always said that apart from affecting the respiratory organs, COVID also affects the major blood vessels of the body, and if the immune suppression is due to any cause, you become more prone to have the disease. Cancer patients are always on immuno-suppressive things and hence are always advised to take precautions, wear a mask even before COVID arrived so that the infection can be avoided. In these unprecedented times of COVID, we have always advised them to follow the same protocol because the chances of getting the severe form of infection and progressing to the critical form of the disease, ICU infection, and death from the disease are more common in cancer patients as compared to the normal people. so be it an undergoing patient, or a patient who is on maintenance, all must follow the necessary precautions to avoid getting infected.

Kashish: Many people are doubting to receive COVID Vaccination due to fear. Do you feel that the vaccine is safe for cancer patients or those undergoing maintenance therapy for cancer?

Dr. Abhishek: The vaccine is safe for everyone including cancer patients, but there are few guidelines which are given on some special suggestion that everybody needs to follow. Coming to the people who have already undergone transplantation for conditions such as hematological malignancies, they are advised to at least get three months' time after the completion of their transplant to get vaccinated because they are already on immuno-suppression so it might not help them like normal people. People who are having hematological malignancy and receiving cytotoxic therapies (chemotherapy) are advised to check for the neutrophil (a type of white blood cell) count. Until and unless the neutrophil count is normal, the patient must delay vaccination because ultimately, his/her ability to fight the disease is not proper. If the neutrophil count is okay, one can get the vaccine.

People with solid malignancies such as breast cancer or lung cancer are advised to get the vaccine whenever it is available, and it will always go on the advice of the treating oncologist. So as I said, the people who are on chemotherapy are advised to give a gap of three months and in most cases, it is advisable to take the vaccine. People who are on Radiotherapy are advised to take the vaccine if their surgery has been done, so probably for them, there must be a gap of few weeks.

If you are taking steroids for any reason, it is advisable to discuss with the oncologist, as many of the companies producing vaccines have indicated that when a person is already on steroids, probably the corticosteroid may reduce the response to the COVID vaccine. So, you should always discuss with the oncologist.

If a cancer patient has had a history of a serious allergic reaction, then there comes a serious need to concern the oncologist otherwise it can really make them land into a problem. The cancer patients who have already undergone and recovered COVID infection can delay the vaccination to three or six months depending upon the antibody titer. There are no special guidelines for cancer patients if you are thinking about the vaccination.

Kashish: At last, would you like to share some tips/advice for cancer patients/survivors and their dear ones to remain emotionally stable and stronger amid these unprecedented times?

Dr. Abhishek: I think I am not the right person to give them advice because probably whatever learning I have had from them is incredible. Cancer patients teach you to be humane in your life, to be humble in your life, to always remain positive in your life. It is very difficult for us to explain to somebody that you have 6 months of your life left. Probably, I can't even imagine the intensity of the optimism cancer patients have with which they live the leftover duration of their lives. So, cancer patients are a great source of learning for an oncologist and I will always want to say to them that please keep on teaching us like this because you are a great source of inspiration for us, and you always encourage us to do great works in our life. We feel very lucky to serve you and do a bit from our side for you.

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(Dr. Abhishek Shankar can be reached through e-mail at doc.abhishankar@gmail.com, or via his Twitter handle: @ShankarAbhishek)

– Interview and graphical content prepared by Kashish Rai (Twitter: @KaafyyFilmyy)