Patterns of Care of Gallbladder Cancer During the COVID-19 Pandemic: An Experience of Tertiary Care Centre at Patna, India

Abstract

Introduction: The novel coronavirus disease 2019 (COVID-19), is caused by the severe acute respiratory syndrome cronavirus 2 (SARS-CoV2). The management of cancer patients is very challenging during the COVID-19 pandemic. Cancer itself as well as anticancer treatment leads to compromised immunity of patients with increased risk of infection. This is turn leads to increased hospital visits. It forms a vicious cycle that increases the risk of COVID-19 susceptibility to cancer patients. Patients on anticancer treatment alongwith COVID-19 infection have higher risk of morbidity and mortality.
Aim: To compare the epidemiological characteristics and management decisions in gallbladder cancer patients during COVID-19 pandemic.
Methods: This retrospective study was conducted at All India Institute of Medical Sciences (AIIMS), Patna. Patients were divided into two group pre-COVID (patients attending radiotherapy department from December 2019 to February 2020) and established-COVID group patients (patients attending radiotherapy department from March 2020 to May 2020) with histopathological confirmed diagnosis of gallbladder cancer.
Results: Histopathological confirmed cases of gallbladder cancer (n=85) were analyzed, 56 patients from pre-COVID timeline and 29 patients from established-COVID timeline were selected. During the pre-COVID timeline, 55.4% of the patients directly visited the radiotherapy department while, 24.1% patients directly attended the radiotherapy department during the established-COVID time. This reduction of number of patients at radiotherapy department was statistically significant (p = 0.006). There was statistically significant reduction (p = 0.014) in number of patients attending from rural areas during established-COVID time. Chemotherapy regimen used during pre-COVID and establishedCOVID timeline was significantly (p < 0.001) different.
Conclusion: Cancer patient management during COVID-19 pandemic is an important issue. Chemotherapy increases the risk of COVID-19 infection by reducing the immunity. Single agent oral capecitabine is a good option for patients of gallbladder cancer in the adjuvant or palliative settings with less toxicity and requiring less hospital visits compared to intravenous chemotherapy.