Currently, in India, approximately 4.5 million cancer patients are present, who are either at different stages or in follow-up treatment. Annually, over 1.5 million new cancer patients are registered in India [18]. Patients who suffer from any non-communicable diseases, i.e., cancer, diabetes, cardiovascular disease, chronic respiratory or kidney disease, are more vulnerable to death related to COVID-19 illness [19]. Around 85% of COVID-19 infected patients who died had more than one or more comorbidity [20]. A study showed that among cancer patients, there is an increased probability of up to twofold of getting COVID-19 infection and a fourfold increased probability of death than in normal patients [13]. The case fatality rate (CFR) among cancer patients with COVID-19 is 14% [15].

There are several theories regarding the efficacy of cancer treatment modalities during the COVID-19 outbreak. To date, researchers have not found any evidence to draw conclusions regarding whether cancer treatment is effective or whether it should be postponed further during a pandemic. A study also reported that the majority of cancer patients presenting to hospitals at an advanced stage are not getting appropriate treatment because of COVID-19 and feeling threatened with life [12]. A cohort study found that twenty percent of patients who were positive for COVD-19 also had an associated diagnosis of cancer. Their treatment was postponed for 30 days [21], i.e., chemotherapy and surgery did not show any poor results in this study, which again indicated that postponing of cancer treatment within 30 days showed no negative effects on the outcome of the cancer patient. Another study evidence showed that delays in cancer surgery increase the risk of disease progression and further increase the chances of metastatic disease and decrease life expectancy and survival of patients [22]. If cancer surgery is postponed for three months, there is a reduction in average life-years gained (LYG), and resource-adjusted life-years gained (RALYGs) per patient, so prompt action is of utmost importance for any cancer patient [23].

During the COVID-19 pandemic, regular screening of each patient with RT-PCR with either oral or nasal swabs for COVID-19 was mandatory within 72 hours before any elective surgery [24]. During any emergency surgery, there was an exception, i.e., a patient’s life-threatening condition. Research evidence shows that if surgery is postponed for any cancer patient for four weeks, it is further associated with increased mortality and decreased pulmonary complications [13].

Globally, there is an acute shortage of personal protective equipment and N95 respirators, and this problem is worsening in developing countries like India [25]. There was a lack of research on whether the use of PPE showed any significance under this COVID-19 scenario during surgery. The CDC also recommended the use of N95 respirators during high-risk procedures only but did not mention surgical procedures [26]. In developing countries, non-academic institutions or smaller hospitals also have a major issue with insufficient budgets. Therefore, the availability and efficacy of PPE were the main challenges faced by surgeons in India [25]. Another study showed that the non-compliance rate of healthcare workers in operation theatres was 7%, which could be another method of COVID-19 transmission among health care professionals [14].

During the COVID-19 pandemic, various surgical societies offered little guidance and advice for minimally invasive laparoscopic and robotic surgery [27]. All societies point out that there is no significant evidence regarding the avoidance of minimally invasive laparoscopic patient surgery for cancer [28, 29]. It not only provides main benefits but also shortens the length of the hospital stay of the patient, which is very much a critical situation currently.

Chemotherapy is another treatment modality used for the treatment of cancer patients. During any chemotherapy, there is always a requirement for logistics and chemotherapeutic drugs. For example, oral chemotherapeutic agents and their proper scheduling should be correlated to minimize exposure and further reduce hospitalization among cancer patients [30]. Prioritization of patients should be properly met, and it must be a joint decision of patients, caregivers, and physicians. Cancer societies must provide guidelines for cancer practitioners during this difficult period to meet the local needs of every cancer patient.

Radiation therapy is also mainline of treatment for cancer. The treatments last for a few weeks, in which each fraction of the treatment is often given for a few minutes. Radiation therapy mainly requires minimal exposure time if appropriate precautions are taken. During the COVID-19 pandemic, hypo-fractionation, advanced prevention, and preparation strategies for radiation therapy have been used to minimize exposure [31]. Cancer societies provided guidelines for the treatment of cancer patients during this difficult period. A study conducted among cervical cancer patients showed that each oncologist followed a “Do No Harm” approach during the treatment of cancer patients. During cancer service delivery, oncologists try to minimize the risk of infection by adopting a holistic approach for the therapy and diagnosis of cancer patients in India [16].

Palliative care is very much a priority in the case of any pandemic, as palliative patients need supportive care all the time [32]. IAPC provides guidelines for providing palliative care and treatment for advanced cancer patients in the COVID-19 pandemic [17]. Palliative care outreach is also very important now, as people who are suffering from advanced cancer may not be able to reach the hospital and also lack family or financial support [33]. Traveling to the oncology center was also difficult for specialist oncology. Therefore, psychosocial treatment, multi-disciplinary coordination, and proper distribution of resources were required to manage this situation. Other healthcare staff should be further trained and prepared to deal with symptom management, alternative strategies, and bereavement support for patients and family members. In pandemic scenarios, the main focus of palliative care should be early discharge of patients from cancer institutions and if possible, provide palliative care at home or with their loved ones [34].

During a pandemic, the government of India started telemedicine consultations in which there were no social contacts, which is a valuable asset for both patients and healthcare professionals [35]. The risk-adapted model was selected for it, i.e., patients who were already registered in the hospital and who were on follow-up can easily assess telemedicine consultation [36] in the near future before the pandemic is over.

Globally, in the pre-COVID-19 situation, cancer units were overworked, with a huge number of cancer patients among developed and developing countries [9]. Due to COVID-19, cancer patients are diverted to an oncology unit. Therefore, in the near future, the service of cancer care facilities will not be able to combat the demand for cancer care. The management of older patients, along with newly diagnosed cancer cases in the coming months, will be a huge challenge. This extremely difficult scenario needs to be addressed on an urgent basis in order to avoid delays in treatment, reduce psychological trauma for cancer patients, ensure the long-term survival of cancer patients, and reduce the burn-out of medical and nursing staff. In addition, countries like India should make a plan for cancer preparedness and a response plan for their cancer patients with COVID-19 positive diagnoses.

Similar to cancer patients, physicians are also vulnerable to extreme mental stress during this crisis. This includes extended and exaggerated working hours, lack of breaks, and a constant need to be alert in a high-risk setting. The CDC reported in August 2020 that about one in four hospital employees seriously faced declining mental wellbeing and had suicidal ideation in the last 30 days [37].

During this COVID-19 pandemic phase, cancer patients have suffered from emotional trauma. Research evidence shows that the diagnosis of cancer has a strong association with a profound psychological effect, which changes a patient’s life completely and causes a persistent threat to their survival [38]. Research evidence from China also indicates that COVID-19 triggered a rise in anxiety, stress, insomnia, and depression among patients [39] and their family members. When both deadly diseases combine, they ultimately cause profound psychological effects.

Cancer treatment delivery was offered to each cancer patient as per standard safety protocol. The best treatment decisions were made through proper scheduling and setting of priority [40]. However, the overall quality of life of each cancer patient is very much affected [12]. To date, as per literature research, no study has been conducted in India to assess the quality of life of cancer patients. This issue needs to be discussed with health care administrators and policymakers in the country for further interventions as soon as possible.