COVID-19 cancer monitoring project in India: Need of the hour

Although there have been many controversies regarding actual mortality figures related to the Coronavirus 2019 (COVID-19) pandemic in India, the country remains one of the most seriously affected worldwide [1].

India is a vast country with a diverse population, and the weaknesses of the healthcare system have had a considerable impact on infection rates and mortality from the disease. Estimates suggest that the actual mortality figures may be considerably higher than those officially declared [2]. Numerous studies have confirmed that patients with cancer are at a higher risk of COVID-19 infections. It has been additionally reported that COVID-19 infections are associated with increased morbidity and mortality in patients with cancer.

In India, owing to factors such as vaccine shortages and patient accessibility, equitable vaccine coverage has remained an issue of considerable concern [3]. Reports have demonstrated the occurrence of hospital-acquired COVID-19 infections worldwide. In low-middle income settings, the acute shortage of infrastructure and staff increases the likelihood of hospital-acquired COVID-19, and case fatality rates are also higher [4].

A statement from the European Society for Medical Oncology recognizes cancer patients with active disease on treatment, chronic disease after specific treatment, and in the survivorship phase to be at higher risk of COVID -19 infections [5]. The statement directed towards member states of the European Union underlines the need to vaccinate all on active treatment for cancer, monitor the effects of the vaccine in these patients, and educate them regarding vaccination with up-to-date information. Nevertheless, the national vaccination program in India has placed cancer in the same category as other comorbidities, which are not associated with the same degree of immunosuppression as many cancers. In this context, it is noteworthy that a large proportion of the population in India continues to be socioeconomically disadvantaged; poor housing conditions, overcrowding, inadequate clean water supplies, and issues with sanitation and hygiene increase the risk of virus transmission manifold. Poor nutrition also adds to the degree of immunosuppression in these patients. It is therefore evident that patients with cancer in India are at higher risk of being affected by COVID-19 compared to their counterparts living in more developed countries. The fact that India has a remarkable demographic profile further compounds the long term concerns; not only is it one of the most populous countries on the globe, it also has the youngest population worldwide. Data from institutional cancer registries have confirmed that cancers among the teenage and young adult population is on the rise; these patients potentially have many productive years of life remaining, and the significant economic impact resulting from premature mortality and lost years of productivity is an area of considerable concern.

Data from the Global Cancer Observatory indicate that most global cancer-related deaths continue to occur in low-middle income countries [6]. In view of the large numbers of lives lost to the pandemic, it is clear that these high-risk patients are also being affected in considerable numbers. Nevertheless, there are no accurate national estimates of the numbers of COVID-19 infections and deaths among individuals with cancer in India. Certain tertiary institutes have released data regarding COVID-19 infections and mortality [[7], [8], [9]]. However, these reports remain sporadic and scarce, and data from most major cancer institutes in the National Cancer Grid are largely unavailable.

Certain countries have established monitoring projects for the comprehensive reporting of COVID-19 cases in patients with cancer. In the US, the COVID-19 Mortality Tracker uses data visualization techniques for monitoring weekly trends of overall and cause-specific mortality since the onset of the pandemic. The UK Coronavirus Cancer Monitoring Project also delivers meaningful real-time data nationwide to inform clinical decision making.

In view of the difficulties in healthcare delivery in low-middle income settings, added challenges conferred by reallocation of funding and resources in the wake of the pandemic, greater risks of COVID-19 infections owing to poor housing and overpopulation, and inequitable vaccine coverage and healthcare access, cancer patients in these settings are clearly at a higher risk of death than the general population.

A single tertiary institute has planned to initiate a nationwide registry for patients with hematological malignancies in India [10]. Nevertheless, there are currently no initiatives for establishing a nationwide project for tracking COVID-19 infections and outcomes among patients with all cancers. Access to real-time data and comprehensive reporting for clinical decision making are therefore unavailable.

In view of the many difficulties in healthcare delivery and access, urgent initiation of a nationwide monitoring project will serve to deliver equitable cancer care to this vast and diverse population, thereby improving their health.

Funding

None.

Declaration of Competing Interest

The authors report no declarations of interest.