|Ahead of print
Impact of COVID-19 on cancer screening by Non-Government Organizations and the way forward
Chethana Thirthahalli, Punith Shetty
Department of Community Oncology, Indian Cancer Society, Bengaluru, Karnataka, India
|Date of Submission||08-May-2020|
|Date of Decision||30-Jul-2020|
|Date of Acceptance||01-Aug-2020|
|Date of Web Publication||14-Sep-2020|
Department of Community Oncology, Indian Cancer Society, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
| » Introduction|| |
The term, Non-Government Organizations (NGOs), is used in a generic form to represent all institutions other than government departments. NGOs are nonprofit-making agencies that are constituted with a vision by a group of like-minded people, committed to the upliftment of the poor, marginalized, unprivileged, underprivileged, impoverished, downtrodden, and the needy and work closely with the target groups. NGOs are voluntary organization that work in defined areas with predetermined goals and objectives. Focusing on a specific cause and area gives them the advantage to work at the grass-root level to observe and monitor their impact. These NGOs compliment the work of the government and help in reaching out to the needy.
In India, there are various types of NGOs which strive in different areas of development. For this article, let us consider health NGOs working with the cancer field. The Indian Cancer Society, Karunashraya, Global Cancer Concern India, and Caped India are the names of a few well-known organizations working for the cause.
Implications of COVID-19 on cancer screening
For most corporate social responsibility (CSR) funders, decisions on spending CSR funds to address the immediate corona virus disease-19 (COVID-19) issues (e.g., contributing to the PM CARES fund or supporting local relief measures) are being made the priority by corporate leadership. Some businesses are also allocating additional CSR funds for the post-COVID-19 relief phase, and others may do so moving forward. While the actual implications for CSR funding for NGO partners will vary, there is still a lot of uncertainty among CSR fundersas the financial year started in April 2020, and the COVID-19 pandemic came simultaneously. The government has asked that all CSR funds are to be utilized for COVID-19 pandemic as it was the need of the hour. But this has put the cancer screening NGOs at jeopardy.
These NGOs were helping the government activities in awareness and screening of cancer. They have designated team and mechanisms that make the work systematic. Also, it was a win-win situation for government as this brought down the burden on their workforce.
Given the current situation, the beneficiaries coming to the community screening camps are questionable. NGOs may have to screen a lot of general cases to attract people to come to the camp. The cost of these camps will go up as we will need to look at the personal protective equipment's (PPEs) and serological testing for patients. The number of people that can be handled in the camp also comes down due to social distancing factor. Taking into consideration all of these factors, cancer screening which needed to be the top priority due to the increasing cancer incidence, will now have to take a step back due to the COVID-19 crisis.
The awareness sessions play a huge role in imparting knowledge to the people as awareness among the public about cancer is low. The right information provided by the doctors improves the awareness and helps in the early diagnosis of cancer. Myths and the stigma about cancer are no less among the public. According to a study done by Nyblade et al. in Karnataka, stigma was a psychosocial barrier which hampered the cancer care continuum. With the COVID-19 distress, creating awareness among the beneficiaries is a challenge.
Tobacco cessation counseling
The tobacco cessation counseling (TCC) session, which helped many quit tobacco, will be affected, especially the NGOs which have a TCC clinic. Priority is to reduce the smoking habit of benefactors, as the World Health Organization (WHO) states that smokers have a higher risk of COVID-19. But due to reduced workforce and decreased funds, NGOs will have it difficult to continue with TCC. Telephonic counseling can be done as an alternative, but the effectiveness of one-to-one counseling is always better. The desired results may not be achieved by telephonic counseling alone.
Follow-up investigations in hospitals
The patient's navigation to hospitals depends heavily on the support of the local partners. The risk of contracting COVID-19 during travel is high. Even after reaching hospitals, the chances of coming in contact with infected cases have increased, which adds to the fear.
The identified cancer cases in the camps are usually in the premalignant stages and hence their surgeries or procedures maybe deferred leading to issues at a later stage. The pros and cons of the procedure need to be weighed to take an appropriate decision.
The way ahead or “the new normal”
Every crisis brings with it an opportunity to do things differently. This is the time for public–private partnerships to take the best of both and work collaboratively. To start with, cancer screening should be made an essential service. The screening can cover only those with the risk factors for cancer. For this to happen, we need to create awareness about the common cancers and their risk factors among the public. The newspapers and local cable networks can be the newer avenues to give information about the cancer symptoms, danger signs, oral self-examination, and self-breast examination. A helpline at the state level with a dedicated team should be made available, which can provide information, emotional counseling, and patient navigation.
Once this is in place, we can start with screening for those with symptoms, keeping the COVID-19 precautions in place.
We can start with virtual cancer screening for oral cancer wherein images can be taken from the precancerous individual and teleconsultation can be done. The females presenting with any symptoms can be tested by the doctor and based on the severity, future course can be planned. The self-collection of samples for human papillomavirus (HPV) can also be started as the current conditions favor it. The virtual consultations and dedicated helplines will help.
The NGOs can act as a bridge between the patients and the hospitals. The diagnosed cancer patients whose treatment has been hampered because of the pandemic can be assessed by NGO for COVID-19 so that unnecessary travel can be avoided. The local partners can help in putting together the data of these patients so that video consultations can be done by the doctor. Based on the outcome of video consultation and weighing the risk benefit of the treatment versus risk of COVID-19 in hospital, further decisions can be taken. The cancer survivors can be assessed by the doctors over the phone and certain basic laboratory tests can be planned where deemed necessary, and wherever possible, intravenous medications can be replaced by oral drugs. NGOs can do emotional counseling which will bring down their anxiety and stress. The NGOs can identify local partners in the various districts who could help in the laboratory testing/imaging and also in the transportation of cancer patients to tertiary care hospitals.
| » Conclusion|| |
The burden of COVID-19 needs to be evaluated in the days to come. The non-COVID-19 deaths will be high because of the disrupt the pandemic has caused in the functioning of NGOs. The number of cancer screening camps by the NGOs will reduce because of the increased cost and requirement of additional workforce. Awareness needs to become more digital, and ways to improvise holds the key. A dedicated patient navigation system should be developed right from the beneficiary's local station to the hospital with dedicated time slots.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| » References|| |
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