Breast Cancer Care During COVID19 – my experience at CK Birla Hospital, Gurgaon

The current COVID19 pandemic has affected the way all doctors practice and oncologists are no exception. Over the last 2-3 months, we have witnessed a lot of changes in treatment protocols, attitude of cancer patients towards their disease and the behavior of newly diagnosed breast cancer patients. Rather than going into technical details regarding the treatment protocols which we are following (which are an Indian modification of American/ European guidelines, most suited for our breast cancer patients at CK Birla Hospital), I will be discussing changes which we have made as doctors and how are our patients coping with the pandemic.

When the lock-down was announced in mid March, fear & panic is what prevailed amongst the patients and they were initially apprehensive in coming to the hospital for their surgery/ chemotherapy. But by early April, it was clear to patients that COVID will persist for a few months and although the world might be in lock-down but the cancer brewing inside their body would continue to grow and they would need to fight it out.

This change in patient attitude coupled with the proactive management at CK Birla Hospital (specially measures taken to improve patient and staff safety), we were able to carry out breast cancer treatment smoothly, even during the lock-down.

During the two months of lock-down, 94% of our breast cancer patients continued their chemotherapy. The ones who skipped some cycles were patients with metastatic disease, who wanted a ‘chemotherapy holiday’. In this period, my unit also operated 22 breast cancer patients. The number of benign (non cancerous) breast surgeries dipped dramatically during this period but we have seen a rebound increase in such cases since the lockdown norms have been eased.

After talking to a lot of friends & colleagues in UK/USA, I realised that I will only be able to take care of my patients if I stay healthy and disease free. To ensure that, in addition to the measures implemented by the hospital, I have also started using extra precaution in the form of a 3M 6200 mask with two p100 filters, which keeps the smoke plumes (thought to be a the leading case of infection in surgeons & anaesthetists) away. Of course, my OCD of hand washing has also served me well during this period 😊.

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Our breast cancer patients have also adapted well over the course of the last 2 months. Our unit has a very active cancer support group known as ‘Vijay’ and all the members have devised new methods to keep in touch with each other during these tough times.

In the pre-covid times, old patients used to visit the new patients on the day of their surgery/ first chemotherapy. This is has been replaced by zoom group calls to support newly diagnosed patients. Even our treatment completion celebrations have undergone a lot of change. Earlier, these used to be elaborate affairs where the patient’s family & the treating team would participate actively, but now we have toned it down (but not stopped it, as it is a very important landmark in the patient’s life) to a simple cake cutting with everyone wearing masks.

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To summarise, my biggest learnings during this period have been

  • Cancer care has to go on but we should be willing to adapt our treatment strategies after a thorough discussion with the patient
  • The safety of the treating team & patients is of paramount importance in order to deliver seamless breast cancer care during this outbreak

 

 

This article has been written by,

Dr. Rohan Khandelwal

Principal Consultant – Breast Cancer Surgery

CK Birla Hospital, Gurgaon

rohankhandelwal@gmail.com

Breast Cancer Care During COVID19 outbreak

At present, almost half the world is in lock-down due to the corona virus outbreak and it is difficult to predict for how long this situation might remain the same. In India, it is almost certain that the lock-down due to COVID 19 will be extended till at least end of April. Even though we are in a state of lock-down but our body is still functioning and that means diseases like cancer might still be growing inside our system. So how does one deal with a problem like breast cancer/ breast lump during this period.

Tips for existing breast cancer patients

  1. Remain in touch with your treating breast cancer surgeon/ breast cancer oncologist. They will outline the treatment protocol during this period
  2. If you have an early stage breast cancer which is curable, you should not defer your treatment during this period, as it can lead to progression of the cancer.
  3. If you are suffering from cancer which has spread to the body (metastatic breast cancer), then discuss with your doctor if the chemotherapy frequency can be reduced or if you can be shifted to hormonal therapy/ oral treatment for the time being.
  4. Corona virus infection is usually severe in patients who are suffering from pre-existing conditions like cancer, diabetes, hypertension. So, please take all precautions to prevent infections
  • Eat a healthy/ balanced diet. Avoid outside food.
  • Make sure you take your daily dose of  vitamin C. This can either be in the form of a supplement or just a glass of lemonade
  • If you are undergoing chemotherapy (which can lead to reduced immunity and white blood count), please monitor the blood counts and if they are low, consult your breast cancer doctor immediately
  • Wear a mask whenever you are venturing out of your home, especially, when you are going to the hospital
  • Maintain strict hand hygiene. Wash your hands multiple times a day and use a hand sanitizer liberally

 

 

 

 

Recently detected a breast lump – what should you do during this period?

During the lock-down, lot of ladies are taking out time to carry out breast self examination and they are picking up new breast lumps. If you are one of them, I would advise that you consult a breast lump surgeon immediately. This consultation can either be an online consultation or a physical visit to the hospital. In an online consultation, if the doctor feels the need to carry out a physical examination, he/she would call you to the hospital.

A breast lump should not be ignored because if it is cancerous, it can increase in size during this period. A mammography or an ultrasound should be done after physical examination and if the lump is suspicious, a biopsy/ needle test should be done to confirm the diagnosis. If the breast lump turns out to be non cancerous (benign), then the treatment can be deferred till the time COVI19 situation improves. Your doctor can provide you medicines during this period to deal with the problem/ breast pain associated with the lump.

If the lump turns out to be breast cancer, as I have highlighted above, please consult your doctor and make a treatment plan which is suitable to you.

These are testing times for everyone, including patients. One has to be cautious about not getting infected by the virus as well as make sure that their breast cancer/ breast lump treatment doesn’t suffer. If you follow the tips which I have highlighted above, you can tide over this phase without compromising your health.

 

 

This information has been provided by

Dr. Rohan Khandelwal

Breast Cancer Surgeon

CK Birla Hospital, Gurgaon

To book an online consultation with Dr. Rohan Khandelwal, click here

 

World Cancer Day 2018

On the occasion of #worldcancerday, I would like to share the picture of the youngest #breastcancer patient I have treated till now.

She is a 25 year old, mother of a 2 year old who came to me with a small breast lump which she picked up after reading a Hindi article on breast cancer.

Few things which I would like to highlight through this case:

1. Age at diagnosis is reducing. This was my third patient in the 20’s over the last 3 months. Majority of my breast cancer patients are in their 30’s.

So, if anyone you know is suffering from a breast lump, please get it checked.

2. Awareness is increasing, which is an excellent thing. I am seeing a lot of patients with stage 1 and 2 disease, which leads to better survival.

To help create more awareness, each one reading this post should tell one more person about breast cancer and it’s symptoms (painless breast lump, recent change in shape of the breast, bloody discharge from the nipple)

3. Another heartening point is the change in the society’s attitude towards these patients. Friends and family members are becoming more accommodating towards the needs of cancer patients.

Please share this message to create more awareness.

This message has been shared in public interest by Dr Rohan Khandelwal, who is a Breast Cancer Surgeon at Gurgaon / Delhi NCR

Scalp cooling device to reduce hair loss during chemotherapy

Hair loss during chemotherapy can be a huge psychological and physical blow to a lady. Today, we tried the Paxman scalp cooling device on two of our chemotherapy patients. This device leads to vasoconstriction of the scalp vessels and reduces hair loss during chemo.

Studies done using the device report a 70% reduction in hair loss with Paclitaxel based chemotherapy ( used for breast cancer, ovarian cancer) and a 30% reduction in hair loss with adriamycin (used for breast cancer) based chemotherapy.

 

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The magic of a healthy doctor-patient relationship

The relationship between doctors and their patients has received philosophical and spiritual attention since the time of Hippocrates and still remains a keystone of care. But, unfortunately over the years, this special relationship has undergone a drastic transition. The onus for this actually lies on both the parties. On one hand, increasing number of litigations and the irrational use of social media has made the doctor fraternity more cautious while on the other, many patients claim that doctors treat them as consumers and the healing touch and warmth has gone.

Bobby Fischer once said “Nothing is so healing as the human touch”. As a doctor, it’s very important to counsel & interact with patients, so that their fears regarding the disease can be alleviated.

As a cancer surgeon, I feel that a healing touch is as important as a good surgical hand. Every doctor should make a sincere effort to strike a healthy relationship with their patients.

May the force be with you!!

 

 

 

(This was a card I recently received from one of may patient’s, whom I had treated for cancer)

Is it sexual harassment? 

Just got a very interesting message from a patient of mine:
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Should I call it sexual harassment ? Whenever I tell people I have breast cancer👙 they look at my breasts and keep guessing which one 🤔
While I do not bother to look at others kidney, prostate or rectum.

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These warriors are already battling this dreaded illness and they need our full support but the society just makes them more conscious of their disease.
Would love to know your views regarding this.

Free Breast Cancer OPD – Early detection is the best protection!!

 

 

Early detection is your Best Protection!!

 

breast cancer

 

 

Initiative by:

Dr. Rohan Khandelwal

Department of Breast Diseases & Cancer Care

W Pratiksha Hospital, Gurgaon

How to interpret an ER/PR report in Breast Cancer

All human cells have some receptors present on their surface. Normal human breast cells respond to the female hormones i.e. estrogen & progesterone, therefore they carry estrogen (ER) and progesterone receptors (PR).

Like healthy breast cells, majority of the breast cancer cells also possess ER & PR receptors. Every breast cancer is different and knowing the fact whether the breast cancer is positive for ER, PR receptors, has an important bearing on the management of the patient’s disease. If a patient’s breast cancer shows these receptors, then they can be subjected to hormonal therapy, which can control the tumor growth by blocking these receptors.

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Sometimes during the course of treatment, the breast cancer cells which are ER, PR positive initially can lose the receptors and become ER, PR negative and they stop responding hormonal therapy. Rarely, the opposite of this is true as well.

Considering this background, it is important that a lady knows how to interpret the hormone receptor status report & understand the implications in breast cancer management based on this report.

Most laboratories used a special method to stain these receptors known as IHC (immunohisto-chemistry). Each lab has their own way of analyzing these receptors, which is why I am covering the most commonly used methods:

  • A percentage that tells you how many cells out of 100 stain positive for hormone receptors.You will see a number between 0% (none have receptors) and 100% (all have receptors).

 

  • Allred score between 0 and 8. This system looks at what percentage of cells test positive for hormone receptors along with the intensity of staining. This information is then combined to score the sample on a scale from 0 to 8. The higher the score, the more receptors were found and the easier they were to see in the sample.

 

  • Positive or negative report

 

Different labs have different cutoff points for calling the cancer either positive or negative. For example, if less than 10% of your cells — or fewer than 1 in 10 — stain positive, one lab might call this a negative result. Another lab might consider this positive, even though it is a low result. Some studies have shown that even cancers with low numbers of hormone receptors may respond to hormonal therapy. A score of “0” means that the patient is hormone receptor negative and will not benefit from hormonal therapy.

Some points to remember

Once the report is declared, your oncologist with discuss your hormone receptor report with you and these are some points, which will help you in understanding your report:

  • ER+/PR+:Majority (65%) of the Breast cancers are ER, PR positive and these patients are candidates for hormonal therapy.
  • ER positive but PR negative OR ER negative but PR positive:Around 10-13% patients fall in these two categories. Despite one of the receptors being negative, these patients are still candidates for hormonal therapy.
  • ER-/PR-:Around 20% patients fall in this category and they are not considered to be candidates for hormonal therapy.

 

If your test result is positive for ER/ PR, you should discuss the role of hormonal therapy with your oncologists. Hormonal therapy helps in preventing the recurrence of disease in patients with localized breast cancer whereas it keeps the tumor growth under control in patients with metastatic breast carcinoma.

 

Article by:

Dr. Rohan Khandelwal

Consultant, Breast Onco-Surgeon

W Pratiksha Hospital,

Gurgaon, India

Multifocal vs. Multicentric Breast Cancer

multifocal vs multicentric

Multifocal breast cancer is defined as the presence of two or more tumor foci within a single quadrant of the breast or tumor foci within 5 cms of each other.

Multicentric breast cancer is defined as the presence of two or more tumor foci within different quadrants of the same breast or tumor foci separated by more than 5 cms.

With the advent of better imaging modalities, these tumors are being detected more frequently and it is important to understand their impact on the surgical management.

Patients with multifocal breast cancer are eligible for breast conservation surgery (BCS; provided no other contraindications for this procedure are present) whereas BCS is avoided in patients with multicentric tumors. 

Another point of interest to both the patients and the doctors is that the diagnosis of a multicentric or a multifocal tumor does not affect the overall survival of the patient.