Background: Every sixth death in the world is caused by cancer and it is estimated that nearly 10 million deaths in 2020 are attributed to cancer. Uninterrupted management is instrumental for the quality of life and prognosis of these patients. Delivering care for patients with cancer during COVID 19 crisis is challenging. Empirical evidence of the impact of COVID 19 in the management of cancer patients is vital for implementing appropriate measures to continue cancer care while battling COVID 19 pandemic.
Aim: To assess the impact of the COVID-19 pandemic on the management of cancer patients at Apeksha Hospital, Sri Lanka.
Methods: A descriptive cross sectional study was carried out at Apeksha Hospital from April 2020 to September 2020. Ethical approval was obtained from the Ethics Review Committee of KIU (KIU/ERC/20/60). A sample of 225 patients with cancer, aged 18 years or older were enrolled in the study. Critically ill patients or patients experiencing an acute psychiatric episode were excluded from the study. Pre-tested interviewer-administered questionnaire was used for data collection. Data were analyzed using descriptive statistics such as frequencies, percentages, means, and standard deviations. IBM SPSS version 25 was used as the data analysis tool.
Results: The mean age of the participants was 42±14 years. Majority of the participants were unmarried (n=151, 67.1%), females (n=158, 70.2%). The commonly reported cancers were, blood cancer (n= 50, 22.2%), breast cancer (n=43, 19.1%), ovarian cancer (n=29, 12.9%), sarcoma (n=23, 10.2%) and cervical cancer (n=22, 9.8%). The majority (n=222, 98.6%) reported that their treatment was delayed due to COVID-19. Withholding clinics (n=173, 76.9%), fear of COVID 19 (n=161, 71.6%), lack of chemotherapy drugs (n=90, 40.0 %), delay in CT/MRI scan (n=89, 39.6%), lack of transport facilities (n=68, 30.2%), lockdown condition (n=53, 23.6%), financial issues (n=31, 13.8%) and postponing surgeries (n=16, 7.1%) were the commonly reported reasons found for the delay in treatments. Only 16% (n=36) had sought alternative methods such as faith pacification, seeking ayurvedic treatments and getting temporary treatment from the family doctor to manage the progress of cancer during the COVID-19 period.
Conclusion: The COVID-19 pandemic substantially disrupted cancer management. The study highlights the necessity of appropriate provisions to continue cancer treatment during the COVID-19 pandemic.

Keywords
Cancer patients , Cancer management , Treatment default , Treatment delay , COVID 19 Pandemic