Challenges in Delivering Care for Hematolymphoid Disorders during the COVID-19 Pandemic : Insights from a Tertiary Center in Kerala, India

Abstract

Background: The COVID-19 pandemic led to significant reallocation of healthcare resources toward emergency care, often at the cost of patients with non-COVID conditions. Individuals with haemato-lymphoid diseases, many of whom are immunocompromised and require continuous, intensive therapy, were particularly at risk. This study aimed to evaluate the impact of the pandemic on the care of patients with hematological diseases in a resource-limited setting in India.

Methods: A cross-sectional study was conducted at the Regional Advanced Centre for Transplantation, Haemato-Lymphoid Oncology and Marrow Diseases (RACTHAM), Believers Church Medical College Hospital, Kerala. All patients who received care between April 1st  2020 and December 31st 2020 were included. Data were gathered through structured interviews during outpatient visits or via telephone. Information on diagnosis, care access, treatment disruptions, follow-up delays, and COVID-19-related outcomes was collected and analysed descriptively.

Results: Among the 505 patients interviewed (mean age 47.95 ± 20.5 years; 50.6% male), 74.3% had benign hematological disorders and 25.7% had malignant conditions. Care disruptions due to the pandemic were reported by 13.5%, while 31.3% reported shifting their primary treatment center. Follow-up visits were affected in 4.9% and investigations were deferred in 2.4%. Treatment modification or discontinuation occurred in only 0.6%. Transfusion services remained uninterrupted. Telemedicine was accessed by just 2.9% of patients. Eight patients (1.5%) tested positive for COVID-19, and the overall mortality was 3.9%, largely unrelated to COVID.

Conclusion: While core hematology services such as chemotherapy and transfusion were largely maintained, logistical and access-related disruptions were common during the COVID-19 pandemic. The findings underscore the importance of strengthening decentralized care models, formalizing transition systems, and expanding telemedicine in hematology to ensure continuity of care during public health crises.