Treatment of cancer under the impression of the COVID-19 pandemic is associated with completely new challenges. Based on several underlying factors cancer patients per se harbor an increased risk for the dismal outcome of COVID. Age, malnutrition, pre-existing lung disorders, and immune suppression comprise the most notable factors to be taken into account in cancer patients. As radiotherapy is one of the major pillars in oncology, there is an urgent need for recommendations on how to deal with various facets of COVID-19 in the framework of radiation oncology. 

Dr. Saurabh Goswami is skilled with the high Precision state of the art of Radiotherapy and Brachytherapy techniques. Dr. Goswami is an eminent personality in his field. He has undergone specialized training in 3DCRT/IMRT/VMAT techniques of various sites of Cancer. He has many posters and paper publications to his credits. His Holistic approach towards treating cancer patients is highly appreciated.

Handling the fears of a patient and the cancer

Cancer is a scary word that evokes strong feelings. Whenever we hear about this disease, the first thing that comes to our mind: that it’s a killer disease and everything will be over in some time. Dr. Saurabh throws light on this, “Yes it is true when any person comes across the word cancer whether it's affecting him or their relatives it may produce fear and it changes the life of a person 360°. Well it shouldn't. Many patients come with preconceived notions about cancer that are inappropriate and often scarier than the reality. For all cancer patients counselling plays the vital part to keep them fighting disease and  also they can defeat this with a positive mindset and approach. In this era we usually expect to cure early forms of breast, colon, prostate  cancers and even advance forms of cervical, testicular and lymphomas malignancies. Fear of patients gradually start vanishing when they see the right approach of treatment improving his life physically and that turn around and boost him up mentally, once we take out fear of the patient half of the battle is already won so again I will say right counselling of cancer patients multiple times help in getting cure with the treatment,” he says.

Can cancer be prevented in the coming 10 years?

A WHO report reveals that one in 10 Indians will develop cancer during their lifetime and one in 15 will die from the disease. The numbers look scary but how successfully can this be prevented in the coming 10 years. Dr. Saurabh positively says that “Recently, NCRP (ICMR), Bangalore, has published a report and the projection of rates for the periods 2010-2020. The total cancer cases are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020. So yes it is scary the rise in number is significant and slowly cancer is surpassing cardiovascular disease as the leading cause of death globally in many countries. Yes, but that's also true with time advancement in medical treatment and newer experiments in genetic and molecular level giving us new weapons in the form of targets and immunotherapies to fight against cancer. I hope one day we will reach the time where we will say we can completely cure cancer of any stage,” he says.

Classification of cancers

Dr. Saurabh throws light on the classification of cancers. “Cancers are broadly classified in four stages I and II considered as early stages and III and IV as advance stages, subclassification in TNM group (ie  Tumor size and spread, Nodal involvement and Metastatic spread to other organs) is more relevant in medical terms it's complex and variable for every site of cancer,” he says.

Cancer is genetic but not inherited

“Yes some of the cancers are genetically inherited and have genetic predispositions like breast cancer, hematological malignancies like leukemia. But cancer is not inherited. It is only the genetic defect that can lead to cancer that is inherited, which means that the predisposition to getting cancer, or increased risk, can be inherited. According to current estimates, only about one in 10 cases of cancer is associated with hereditary predisposition. The genetic changes that occur in cancerous tumours are not passed on genetically to one’s offspring. Still we are progressing further to  understand the genetic study,” explains Dr. Saurabh.

Effect of COVID-19 on Indian healthcare

The COVID-19 has a significant impact on our health system, says Dr. Saurabh, “You can understand by this patient category divided in all major hospitals in two categories one for COVID patients and other all ailments come under non-COVID patients. Especially for cancer patients it's a challenge to continue the treatment or to begin with. All cancer treatment whether it's chemotherapy, radiation therapy, and surgery makes patients immunocompromised and in this scenario, if they catch COVID-19 infection, it can be fatal. So with utmost precautions, we are offering treatment to cancer patients. It's the toughest challenge for us as a health care professional and same for patients too,” he says.

Dealing with the pandemic

“Within this 4 months span of time, I am personally learning and becoming stronger day by day to fight against cancer with this corona in our life. We haven't stopped treatment for a single day for cancer patients in the last 4 months and for that, I want to thank all my staff who stand as a pillar to support our medical system and patients,” says Dr. Saurabh.

Can genomics help in the early detection of cancers?

“Genome study plays a pivotal role in early diagnosis and even in the treatment of the cancer patients by targeting those mutations. For example Mutations in the tumor-suppressor genes BRCA1 and BRCA2, for example, have been linked to a much higher risk of breast, ovarian, and prostate cancer another example, HER2-positive breast cancers involve a mutated HER2 oncogene, which produces a protein that increases the growth of cancer cells. chronic myeloid leukemia (CML) is diagnosed by the presence of a mutated gene called BCR-ABL. Having the right diagnosis is the most potent determinant of getting the right treatment,” he says.

Foods to avoid or eat to kill cancer cells

There are several types of foods if ingested for the long term shows a relationship with a higher incidence of cancer and needs to be avoided:

• Processed Red meat
• Refined sugar and 
• White flours
• Soda's
• Hydrogenated oil used to preserve processed food. 
• During chemotherapy, the patient is immunocompromised, so during that time avoid raw food
• Oily and spicy food
• Intake of good carbs, fats, and proteins which is easily digested will help

The treatment of cancer is mentally exhausting 

The psychological impact of cancer is so harsh that the treatment of cancer itself looks like a big challenge. “I  have seen different categories of patients. One category who is mentally strong head finishes the treatment effortlessly and has minimal side effects and another category is those who really struggle to complete the treatment and have major ailments during treatment. I will not hide the fact that yes the treatment is traumatic involving surgical morbidity, cytotoxic drugs during chemotherapy having significant side effects on patients including change in physical appearance by the skin becoming pale, losing hairs, etc and radiation-related skin pigmentation, dysphagia, etc but the instinct of survival and proper counseling during treatment make a larger impact on patients to go through this treatment. With the advancement in diagnosis,  techniques of treatment with radiation therapy, evolution with target and immunotherapies having target specific drugs having minimal side effects, the introduction of robotic surgeries reduces surgical morbidity has shown us a bright future ahead to reduce treatment-related side effects,” says Dr. Saurabh.

(Edited By Rabia Mistry)