Impact of COVID-19 on cancer care in India: a cohort study
Open accessAbstract
Background The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India.Methods We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019.Findings Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities).Interpretation The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial.Funding None.Translation For the Hindi translation of the abstract see Supplementary Materials section.
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Prior studies have reported reductions in care quality for cancer patients (e.g., fewer follow-up visits, fewer chemotherapy courses administered, and fewer surgeries performed) as well as reduced cancer screening and diagnosis of new cases within India during the pandemic.
“Prior studies have reported reductions in care quality for cancer patients (e.g., fewer follow-up visits, fewer chemotherapy courses administered, and fewer surgeries performed) as well as reduced cancer screening and diagnosis of new cases within India during the pandemic52–54.”
From Attributed causes of excess mortality during the COVID-19 pandemic in a south Indian city (2023) · cites this paper as [52]
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- Authors
- Ranganathan, P., Sengar, M., Chinnaswamy, G., Agrawal, G., Arumugham, R., Bhatt, R., Bilimagga, R., Chakrabarti, J., Chandrasekharan, A., Chaturvedi, H. K., Choudhrie, R., Dandekar, M., Das, A., Goel, V., Harris, C., Hegde, S. K., Hulikal, N., Joseph, D., Kantharia, R., Khan, A., Kharde, R., Khattry, N., Lone, M. M., Mahantshetty, U., Malhotra, H., Menon, H., Mishra, D., Nair, R. A., Pandya, S. J., Patni, N., Pautu, J., Pavamani, S., Pradhan, S., Thammineedi, S. R., Selvaluxmy, G., Sharan, K., Sharma, B. K., Sharma, J., Singh, S., Srungavarapu, G. C., Subramaniam, R., Toprani, R., Raman, R. V., Badwe, R. A., & Pramesh, C. S.
- Affiliations
- Homi Bhabha National Institute (IN)
- G. Kuppuswamy Naidu Memorial Hospital (IN)
- Chittaranjan National Cancer Institute (IN)
- Malabar Institute of Medical Sciences (IN)
- Max Super Speciality Hospital (IN)
- Bhubaneswar Borooah Cancer Institute (IN)
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (IN)
- Ruby Hall Clinic (IN)
- Sri Venkateswara Institute of Medical Sciences (IN)
- All India Institute of Medical Sciences Rishikesh (IN)
- Kailash Healthcare (IN)
- Prince Aly Khan Hospital (IN)
- Dr. Vitthalrao Vikhe Patil Foundation’s Medical College (IN)
- Regional Cancer Center, Thiruvananthapuram (IN)
- Gujarat Cancer & Research Institute (IN)
- Bhagwan Mahaveer Cancer Hospital and Research Centre (IN)
- Government of Mizoram (IN)
- Christian Medical College, Vellore (IN)
- Mahamana Pandit Madan Mohan Malaviya Cancer Centre (IN)
- Basavatarakam Indo American Cancer Hospital and Research Institute (IN)
- Cancer Institute (WIA) (IN)
- Manipal Academy of Higher Education (IN)
- Sawai Man Singh Hospital (IN)
- Silchar Medical College and Hospital (IN)
- Kovai Medical Center and Hospital (IN)
- Tata Medical Center (IN)
- Corresponding author
- Pramesh, C S
- ORCID
- Ranganathan, Priya
- Sengar, Manju
- Chinnaswamy, Girish
- Agrawal, Gaurav
- Bilimagga, Ramesh
- Chandrasekharan, Arun
- Chaturvedi, Harit Kumar
- Dandekar, Mitali
- Goel, Vineeta
- Harris, Caleb
- Hulikal, Narendra
- Joseph, Deepa
- Kantharia, Rajesh
- Khan, Azizullah
- Khattry, Navin
- Mahantshetty, Umesh
- Malhotra, Hemant
- Pandya, Shashank J
- Patni, Nidhi
- Pavamani, Simon
- Pradhan, Satyajit
- Thammineedi, Subramanyeshwar Rao
- Sharan, Krishna
- Singh, Suresh
- Srungavarapu, Gowtham Chandra
- Toprani, Rajendra
- Badwe, Rajendra Achyut
- Pramesh, C S
- Venue
- The Lancet Oncology
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 22
- Issue
- 7
- Pages
- 970-976
- ISSN
- 1470-2045 (ISSN-L)
- PMC
- PMC8159191
- OpenAlex
- W3165702866
- Cited by
- 159
- References
- 22
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 23 · 2023: 31 · 2022: 62 · 2021: 20
- FWCI
- 12.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cancer Research UK
- Canadian Cancer Society
- Topics
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advances in Oncology and Radiotherapy
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- COVID-19 pandemic, cancer care, oncology services, healthcare disruption, cancer screening, radiotherapy access, chemotherapy, cancer surgery, palliative care, diagnostic testing, outpatient visits, India, cancer centers, graduate medical education, research activities, health system resilience, health equity, cancer survivorship
- MeSH terms
- COVID-19, Ambulatory Care, Health Services Accessibility, Hospitalization, Humans, India, Medical Oncology, Neoplasms, Patient Acceptance of Health Care, Time Factors, Waiting Lists, Delivery of Health Care, Integrated, Early Detection of Cancer, Delayed Diagnosis, Time-to-Treatment, Hospitals, High-Volume
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