Cancer care continuum at a tertiary care centre in India during the Covid-19 pandemic and nationwide lockdown: Healthcare delivery through telemedicine.

Background The Covid-19 pandemic and subsequent lockdown in India caused disruptions in cancer treatment due to the restriction on movement of patients. We aimed to maintain continuity in cancer treatment during the lockdown through teleconsultations. We tried to reach out to our patients using telephonic consultations by establishing a Teleconsult Centre facility run by a team of doctors and patient navigators. Methods We telephonically contacted all patients who had outpatient appointments from 23 March to 30 April 2020 at our centre through the Teleconsult Centre to understand their current circumstances, feasibility of follow-up, local resources and offered best possible alternatives to continue cancer treatment, if required. Results Of the 2686 patients scheduled for follow-up during this period, we could contact 1783 patients in 9 working days. Through teleconsultations, we could defer follow-ups of 1034 patients (57.99%, 95% confidence interval [CI] 55.6%-60.3%), thus reducing the need for patients to travel to the hospital. Change in systemic therapy was made in 75 patients (4.2%, 95% CI 3.3%-5.2%) as per the requirements and available resources. Symptoms suggestive of disease progression were picked up in 12 patients (0.67%, 95% CI 0.35%-1.17%), who were advised to meet local physicians. Conclusion Our study suggests that the majority of patients on follow-up can be managed with teleconsultation in times of crisis. Teleconsultation has the potential of being one of the standard methods of patient follow-up even during periods of normalcy.

Tata Memorial Hospital: a Peerless Icon.

Few institutes last long and fewer maintain their pre-eminent position throughout their life. They are called temples of their silo. Tata Memorial Hospital and Centre (TMC) is one such temple of healing. The contribution of TMC in patient care, education and research is unique and reasons for its success are varied. It is probably the best  expression of Tata culture, Government's commitment, dedication and autonomy of people who ran it. A glimpse into the journey with its changing vision towards a pointed mission of conquest of cancer in India is captured in words.

Angelina's choice: private decision, public impact.

The decision of the actress, Angelina Jolie (AJ), to undergo preventive risk-reducing bilateral mastectomy has elicited extreme responses, in support and against. We will discuss whether her decision was justified and if there are other options available to women. AJ, who is 38 years old, inherited the BRCA 1 gene. Because of the lack of randomised trials, there is controversy about the overall benefit that various risk-reduction strategies offer carriers of the BRCA 1, but some of the strategies offer a clear benefit. The decision to opt for mastectomy must be driven by the patient's choice, evidence on the balance of the risks and benefits, the quality of life after surgery and issues relating to body image.

Angelina's choice.

This is an opinion piece on how a celebrity's personal choice to undergo prophylactic mastectomy on discovery of an aberrant gene, when publicly promoted, carries in itself the power to influence and impact healthcare trends and decisions. When celebrities advocate causes that are universally and uniformly acceptable and indisputable as the best in the realm of healthcare and cure (e.g. no smoking), it creates well-being and awareness in society at large. But those which are personal choices made out of a repertoire of other available and effective options may, because of celebrity preference, don the mantle of a norm. They thus run the danger of being blindly replicated by others without proper awareness and knowledge of the true potential of disease, risk factors, and other existing remedial or risk-reducing measures. Society should thus be encouraged to question, debate, and understand the validity, authenticity, and reason of the choices, especially those with a medical basis. This tempering of information with intelligence and rationale and making informed choices based on facts will serve humanity as a whole.