COVID has led to unprecedented manifestations for everyone especially patients with acute illnesses who were not only wary of reaching to health care facilities but also faced difficulty in traveling due to lockdown or did not receive appropriate attention for numerous reasons.
Mr HK a 52 year male, tobacco chewer, and a daily wages worker, now with no work came to my OPD (which was continued ion COVID times unhindered) through an old patient in deep anguish due to a large fungating buccal mucosa tumor. Biopsy was squamous cell carcinoma (oral cancer). He had neither funds nor means to take any oncological therapy and government hospitals denied new patients.
Old patient reference had obvious expectations which were important to live up to. I had a task not only to treat effectively but to treat with minimal funds without risking an admission to hospital or requirement of a COVID screening which would have cost an additional 4500 INR (in those days).
I treated him with metronomic chemotherapy and targeted therapy combination using methotrexate, gefitinib and celecoxib (1). All therapy was oral and OPD based.
There is an old saying “I treat though Heals”. The formula worked and responses were evident in each OPD visit. At 6 weeks the tumor had shrunk by 80% and he had no pain and toxicity of therapy. We fulfilled all aims it was effective, cheap, and had no toxicity to warrant admission.
He is now planned for definitive treatment with surgery/radiotherapy.
- Patil VM, Noronha V, Joshi A et al. Phase I/II study of palliative triple metronomic chemotherapy in platinum-refractory/early failure oral cancer. Journal Of Clin Oncol 2019, Nov 10;37(32):3032-41
