In the study, the researchers have divided conditions and diseases into high priority, immediate priority and low priority categories, according to which healthcare authorities across the nation can provide prioritised interventions with the limited resources available. (Representational/pexels)

A review article written by a group of PGIMER doctors and researchers- highlighting the prioritized approach towards treating hematological disorders during COVID-19 in India- was recently published in the Indian Journal for Hematology and Blood Transfusion. “The idea behind writing this plan was to provide a framework with which patients of cancerous and other hematological disorders can receive the treatment they need, despite the restraints of the pandemic and the contagious disease and the subsequent lockdown,” says Dr Pankaj Malhotra of the Department of Internal Medicine, who is also one of the authors of the study.

The review article states that the country is likely to be overburdened by COVID-19, which makes patients with co-morbidities, especially cancer patients in an immunosuppressed state, even more susceptible to a severe, often life-threatening forms of the infection. The review hence “summarises the possible challenges clinicians are likely to face, key considerations to guide decision-making and possible solutions to the anticipated decision-making”. The article gives disease specific suggestions on treating hematological disorders, keeping in mind the restraints of India’s public health set up. Hematological disorders refer to blood and blood forming organs related disorders, which can range from chronic non-cancerous conditions, such as hemophilia, to cancerous diseases such as hodgkin’s disease or leukemia.

Stressing on the need to strategise and plan for hematological treatment, especially for malignant conditions, the article cites studies which have indicated that the prevalence of COVID-19 in cancer patients is at least two per cent and cancer patients have a 3.5 times more likelihood of acquiring the disease than others. The article also cites a retrospective study from three centers in China, which presented a mortality rate of 28.6 per cent in cancer patients admitted to these hospitals. The prevailing circumstances, in the midst of the pandemic, make it all the more important that cancer patients receive timely intervention.

In the study, the researchers have divided conditions and diseases into high priority, immediate priority and low priority categories, according to which healthcare authorities across the nation can provide prioritised interventions with the limited resources available. “The most prioritized disease should be the cancerous diseases, which can be treated with curative therapy, because timely intervention for these diseases might lead to the patient having a longer and healthy life,” explains Dr Malhotra.

According to the article, induction therapy for acute leukemia, and chemo therapy for other acute cancerous diseases, such as lymphomas and myelomas, should be treated as high priority diseases which require immediate intervention. Apart from this, ‘factor support for severe hemophilia with acute bleed’ and ‘anticoagulation for acute thrombosis’ should be in the list of prioritised diseases, for early intervention in hospitals and clinics across the country. Interventions such as post-therapy surveillance in long-term survivors, like post transplant patients and haemophilia patients after elective surgery, have been placed in the low priority list by the researchers.

The researchers have also detailed general recommendations for haematologists working through the pandemic, stressing on the need to maintain individual therapeutic care for all patients on a case-to-case basis. Doctors have been advised to connect with local healthcare providers so that patients receive the treatment they require without having to traveling far and exposing themselves to COVID-19. The review article states that although 70 per cent of Indian population resides in rural pockets, 95 per cent of cancer care is provided in urban settings, which makes it next to impossible to ensure that all cancer patients receive treatment locally with the current system of healthcare in India. Hence, “healthcare facilities may have to continue to deliver cancer care through some strategic reorganisation of resources,” the researchers say.

The study concluded that the review and suggestions are based on limited real-time data on the affect of the pandemic on patients with haematological disorders in India, and the researchers have relied on their “expertise” to consolidate the review study. However, with more data and experience with treatment during the pandemic, guidelines can be modified and applied more efficiently to different contexts. “Physicians catering to patients with hematologic disorders also need to review and implement the rapidly evolving global, Indian and institute specific guidelines and modify them in a way that is best suited to their local situation,” says the study.