Addressing Concerns and Dilemma of Cancer Patients In A Lockdown

For many cancer patients, this situation is a living nightmare as they face not only the threat of Covid-19, the pressure of lockdown restrictions but also intense uncertainty regarding the future of their cancer treatment and its associated outcome

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Cancer
Due to lockdown restrictions cancer patients face intense uncertainty regarding the future of their treatment. Pixabay
By Dr. Abhishek Shankar and Dr. Deepak Saini

The newly emerged Covid-19 virus has changed our lives in many ways. The lockdowns imposed by many countries have closed all but essentials services to prevent community transmission of the virus, with more stringent steps threatened as case numbers and mortality data grow by the minute.

Healthcare, an essential service at any time but never more so than in a crisis such as this, has been severely affected as the primary focus is shifted to the management of the crisis and other health emergencies rather than routine care.

Many elective surgeries are being deferred or delayed and patients are being advised to avoid non-essential hospital visits and switch to tele-consultation for arising problems.

For many cancer patients this situation is a living nightmare as they face not only the threat of Covid-19, the pressure of lockdown restrictions but also intense uncertainty regarding the future of their cancer treatment and its associated outcome.

Cancer patients are facing a stark choice regarding continuing treatment or delaying it to mitigate the Covid-19 risk. Many cancer patients in India travel huge distances to receive treatment but right now they cannot access treatment even if they wish to proceed as airlines and rail services are not operating.

Understandably, patients want concrete answers about when they can start cancer treatment, what the implications are if there is a gap in their treatment on their chances of recovery and the risks for their safety if they do attend the hospital.

There is no one-size-fits-all answer to these questions.

The psychological impact on patients and their families is starting to reveal itself.

Cancer treatment
Cancer patients are facing a stark choice regarding continuing treatment or delaying it to mitigate the Covid-19 risk. Pixabay

The son of a recently diagnosed patients wrote to us: “My father has been diagnosed with kidney cancer with lung metastasis 21 days ago. His immunohistochemistry sample could not be processed in this lockdown and he was advised to stay at home considering his age of 83 years. I am worried about his cancer but at the same time this infection too.”

Another patient’s family wrote: “Is it safe to visit hospital for PET-CT as I have heard that cancer patients are more prone to catch infection?” His mother has colorectal cancer and is post-surgery and post four cycles of chemotherapy. She was scheduled for PET-CT for evaluation but was frightened to approach to the hospital in the lockdown.

In ordinary times, cancer patients face uncertainty and have to fight on many fronts to deal with the economic, social, family and personal challenges that a cancer diagnosis brings. During active treatment cancer patients require frequent hospital visits, pre-operative & post-operative stays, chemotherapy sessions, laboratory tests and radiological imaging, daily appointments for radiotherapy sessions (often over weeks). Extended hospital visits mean that cancer patients, many of whom are immunocompromised as a result of the side-effects of treatment, are more likely to be exposed to infection.

Data emerging from many countries affected by the pandemic suggests that the majority of the Covid-19 patients who require hospitalisation are suffering from heart disease, respiratory disease, diabetes, hypertension or cancer.
Here we have tried to address many of the concerns of cancer to minimise the fear and uncertainly related to cancer treatment and its outcome amidst this Covid-19 crisis.

Which cancer patients are at high risk for coronavirus infection?

Cancer patients who are older (more than 70) and having one or more associated co-morbidities, i.e., cardiovascular diseases, hypertension, diabetes, and lung diseases are at high risk for coronavirus infection.

What are the symptoms of coronavirus disease in cancer patients?

Coronavirus diseases are associated with symptoms which include fever, a new persistent dry cough, difficulty in breathing, fatigue, sore throat. New evidence suggests some patients are experiencing the loss of smell and taste. Presentation of the disease is not different in cancer patients but chances of progression to severe or critical diseases are more common with cancer patients.

Cancer
For many cancer patients the COVID situation is a living nightmare. Pixabay

What are the chances of getting coronavirus infection if cancer patients come to hospital for their treatment?

Chances of getting coronavirus infection does increase with frequent hospital visits. It has been reported between 10 – 30% in reports from different hospitals in China where Covid-19 patients were getting treatment.

Should I visit the hospital?

In this present scenario, the best advice is to minimise the hospital visits for cancer patients and that tele-consultation can be a good alternative to avoid direct contact between patients and cancer care provider for the vast majority of routine appointments.

I am currently having cancer treatment. Should I continue my treatment or stop it as I have to go to hospital frequently for my treatment.

No cancer patients should halt, postpone or cancel their treatment as stated in guidelines from various cancer institutions/societies/hospitals. Patients who are in hospital must adopt the contact and droplet precautions, which means wearing a mask, covering outdoor clothes and extra sanitation steps. Hospital staff should be following the same guidelines. Discuss how to minimise visits with your healthcare provider or if any procedures can be done at home.

My cancer doctor has advised to me delay the surgery/chemotherapy/radiotherapy. Should I follow my doctor’s advice or get surgery/chemotherapy/radiotherapy done at another hospital?

There is a time limit on how long someone can delay cancer treatment without it impacting their recovery. Patients need to have a discussion with their cancer care provider about their unique circumstances. One size does not fit all. In some cases, patients may be reasonably advised to switch to other treatment modalities. If there is an issue related to transportation and stay, patients are encouraged to start the treatment at the nearest cancer centre where appropriate treatment is available rather than travel.

What precautions should cancer patients take amidst the coronavirus crisis?

Cancer patients are advised to practice social distancing, maintaining at least a two-metre distance from anyone who does not share their home. Regular handwashing with soap or alcohol-based hand rub is a necessity. If a member of your household develops Covid-19 symptoms such as cold, cough or fever they should self-isolate as much as is reasonably practical. Patients are advised to avoid crowded places and stay in well-ventilated rooms. Patients are advised not to shake hands and organise longer prescriptions for regular medicines well in advance of running out.

I have been receiving information on WhatsApp, Facebook and other sources about coronavirus prevention and treatment. How can I confirm what is real and what is fake?

A lot of incorrect information has been circulating leading to fear and uncertainty. There are trustworthy information sources available, being updated regularly as new evidence emerges and is evaluated by experts such as the World Health Organization (WHO) and the Indian Council of Medical Research (ICMR). Patients and their caregivers should use these and not rely on social media.

Also Read: Snapchat Brings ‘Lensathon’ to India

In conclusion, cancer patients and caregivers are facing difficult decisions to understand and weigh up the risk and benefits of continuing treatment in its current form in this crisis.

Although current guidelines support the continuation of treatment where possible, patients must talk to their individual cancer care provider to explore if their treatment should be reasonably modified in the ways outlined above to reduce their individual risks of exposure to Covid-19.

(Dr. Abhishek Shankar is Assistant Professor in Radiation Oncology at Lady Hardinge Medical College & SSK Hospital, Delhi. Dr. Deepak Saini is Project Officer at Cancer Control and Prevention Division of Indian Society of Clinical Oncology, Delhi. Views expressed are personal.)

 

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COVID ‘Just the Tip of The Iceberg’ Warns Virologist known as ‘Bat Woman’

Top Chinese virologist, has warned that new viruses being discovered are "actually just the tip of the iceberg"

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Coronavirus
COVID is only the beginning says virologist. Pixabay

A top virologist from China, famous for her work on researching coronavirus in bats, has warned that new viruses being discovered are “actually just the tip of the iceberg”. In an interview on Chinese state television, Shi Zhengli, known as the ‘Bat Woman’ for her research about bats and the viruses associated with them, also called for greater international cooperation in the fight against epidemics such as Covid-19.

Zhengli, the Deputy Director of the Wuhan Institute of Virology, said research undertaken in viruses needs governments and scientists to be transparent with their findings, and cooperative, reports dailymail.co.uk.

She also said that it is ‘very regrettable’ when science is politicised. Speaking to Chinese state television CCTN, Zhengli said: “The unknown viruses that we have discovered are actually just the tip of the iceberg. If we want to prevent human beings from suffering from the next infectious disease outbreak, we must go in advance to learn of these unknown viruses carried by wild animals in nature and give early warnings,” Zhengli was quoted as saying to CCTN.

Coronavirus
COVID and other viruses need more research says an expert. Pixabay

“If we don’t study them, there will possibly be another outbreak,” she added.

Also Read: Scientists Identify 29 New Genes Linked To Drinking Problems

Her interview comes after, both US President Donald Trump and his Secretary of State Mike Pompeo have suggested that the Covid-19 originated in a laboratory in the Chinese city of Wuhan, where the pandemic erupted last December last month. Earlier, Zhengli had also said that even after the world finds a way to combat the virus responsible for Covid-19, it should prepare for more outbreaks caused by bat-borne coronaviruses. (IANS)

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Caring For The Elderly, Tackling Old-age and Loneliness in The Times Of COVID

While we do our bit to stay safe, looking after our loved ones, particularly the elderly, is crucial

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Elderly
Caring for the elderly in these troubled times is very important. Pixabay

BY SIDDHI JAIN 

The Coronavirus pandemic has left human race with feelings of anxiety, uncertainty and a fear what’s coming next. While we do our bit to stay safe, looking after our loved ones, particularly the elderly, is crucial.

In this crisis, just like the little children in the family, our elders also need extra care and attention, especially if they are living alone and are prone to feeling isolated. Coupled with the greater restrictions on the 60+ population stepping out, these feelings can negatively impact physical and mental health, and must be addressed promptly and with care.

In a chat with IANSlife, here are some ways suggested by Dr Ishita Mukerji, a senior psychologist at Kaleidoscope, a mental wellness centre part of Dr. Bakshi’s Healthcare.

Teach them to go digital: Patiently help them learn the use of various video/voice call applications available and encourage them to stay virtually connected with their friends and family. They can also use this time to rediscover their lost art of writing and share short heart felt notes via email, to their loved ones to lift their spirits. Demonstrate to them how to use taxi-hire apps, medical-monitoring apps, emergency call services, and the like. Hand them a copy of all necessary phone numbers and save them on their phones.

Elderly
Looking after our loved ones, particularly the elderly, is crucial. Pixabay

Prioritize their nutrition intake and physical activity: Senior citizens need adequate sleep, optimum nutrition and some kind of physical exercise on an everyday basis. Ensure that their sleep cycle is not disturbed due to the changes in the household because of the factors associated with social distancing. Their daily diet must have a combination of essential proteins and minerals, fruits, green vegetables, dairy products and a lot of liquid, as we are in the peak of summer. Elders might find it tough to exercise within the house, as many go to neighbourhood parks and yoga classes. However, you must help them incorporate at-home yoga and breathing exercises into their routine.

Enjoy recreational activities together: A good way to bond and enjoy as a family is watching a movie, listening to music, indulging in some craft activity, looking through photo albums together or playing indoor games like cards, chess, ludo, monopoly, carom etc or some mind stimulating games like Sudoku or puzzles. These activities will in turn make them feel relaxed, rejuvenated and something to look forward to each day.

Keep them engaged indoors: It is important to involve your family’s senior members in the household activities as much as possible. Their help in such basic activities will let them stay occupied and also give a sense of accomplishment to them but do not push them to perform strenuous activities. You may encourage them to pursue hobbies like reading, writing, knitting, singing or painting. Make sure they have enough supplies to last the crisis. Encourage them to teach young kids a skill.

Involvement in decision-making: We must seek advice and suggestions from the elders in our families at all times, especially when making decisions that might directly or indirectly impact them or their lifestyle. Taking their inputs into consideration will make them feel wanted and heard. It is really important to respect their thoughts and feelings that they derive out of their life experiences and wisdom accumulated over the years.

Create a positive environment at home: Getting exposed to the concerning news around worsening situation for longer durations can create anxiety and fear in seniors’ minds. Create a positive atmosphere and help them keeping calm and positive. Speak to them about their happy times. Revisit old memories, reopen photo-albums, listen to their life experiences and spend quality time with them.

senior citizen
The elderly can also use this time to rediscover their lost art of writing and share short heartfelt notes. Pixabay

Taking care of mental and emotional needs: Pay attention to the thoughts and concerns that the elderly might have as there may be big or small issues where they may need your help to solve them. Look out for mood swings too, as it might mean they are struggling mentally and need extra support and care. Also be aware of any cognitive difficulties they might be facing like being anxious, angry, stressed, agitated or withdrawn. It is very important to provide emotional support to keep them mentally and physically fit.

Also Read: Turn to Yoga For Quitting Tobacco

The elderly have sacrificed a lot in their youth for our sake and it is now time that we show them utmost love and appreciation, signs off Dr Mukerji. (IANS)

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Increased Online Gambling Concerns Legislators, Excites Players

Rise of online gambling was expected during the COVID-19 crisis and the subsequent lockdown

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A sudden increase in online gambling is seen amid the COVID-19 crisis. Pixabay

Although the rise of indoor entertainment, including online gambling, was expected during the COVID-19 crisis and the subsequent lockdown, the level of increase was unsuspected. It is probable that the availability and advantages provided by the online operators were enough to pull in players that haven’t been regulars in traditional establishments, increasing the overall size of the market.

Both due to the fright of possible mass gambling addictions and the probable loss of local gambling tax revenue, many legislators are trying to create an answer to increased gambling. But, aside from some really restrictive measures, nothing has been proving to be effective.

The reason for the rise of online gambling not stopping may be found in both the new type of service, as well as the new type of players. Online operators work under strict supervision and are affected by independent online reviews. On the other side, players have now accepted that playing online games, including gambling, is something done for fun and not a pathway to great riches.

Massive Drops in Traditional Gambling

On average, traditional casinos, betting houses, and sports bars experienced a massive drop of around 30%. In most part this is due to the states and counties that have enforced a strict lockdown and where these establishments are not accepting players at all. Others are seeing drops due to the legitimate scares about catching the virus.

But, the gambling industry as a whole is seeing a rise in the meantime. Both experienced players and those that usually don’t gamble are using the benefits provided by online operators to jump ship and go to the cloud.

Gambling
Traditional casinos, betting houses, and sports bars experienced a massive drop. Pixabay

Although some correction is to be expected once the lockdowns and infections risks pass, it is disputable if they will be enough to revive brick and mortar casinos from their situation. Without some additional advantage that the players will feel there is little chance for total revival.

Local Budgets are at Risk

While there might be some legitimate concerns coming from legislators when it comes to the dangers of gambling, most are concerned by the drop in local budgets. Due to the players opting for international providers there is a visible drop in revenue collected, which would not change in the future.

Unless there is a Copernican change in how these incomes are taxed, local administrations might be facing some serious budget cuts in the perceivable future.

Players Demand Online Benefits to Return

It is now obvious that gambling has become a player’s market where operators and providers will need to compete for every dollar coming their way. This might not be a fair fight for traditional casinos, as the increased overhead costs usually drive gambling options down.

According to Lioncasinos live casino has been the focus of most players exactly because of the benefits provided by operators. Once these advantages diminish, the players usually stick to the same game but change the place where they are playing.

It is questionable if traditional casinos would be able to go head to head with something like doubling your money in bonuses, or allowing for free playing, simply because of the mechanics possible in cyberspace.

Online gambling
Online casinos have an undisputed advantage when it comes to accessibility. Pixabay

Accessibility of Online Gambling

Aside from the advantages when it comes to gaming and betting itself, online casinos have an undisputed advantage when it comes to accessibility.

Unlike traditional establishments that require you to plan and travel to them, adding to the cost of gambling, online options are instant. Anyone can access and play through their smartphone, allowing for many to use gambling services while in transit, or relaxing at home.

Sports Betting won’t Influence the Outcome

Both administrations and brick and mortar operators are having a little bit of their own that sports betting will be the major push back to old ways of gaming once the season resumes. But, the numbers show that odds are not in their favor.

Online operators in general are aware that this situation won’t last and are jumping to acquire licenses and rights to provide sports bets. For the largest international operators these options are already available and might be the preferred choice for future sports bettors.

If the same bonuses, reviews, and betting systems persist for online betting as they do for live casino games, there is a significant possibility that the players will keep their money online.

Also Read: Deal with Orthopedic Issues During Lockdown Easily

But, there is still a chance that the hospitality factor for sports bars offering bets might push some players to return. These bars will need to focus on their distinct real-time advantage and atmosphere, as the old way of doing business probably won’t exist in the near future.

[Disclaimer: The article published above promotes links of commercial interests. ]