Background and Objectives: The COVID-19 pandemic impacted health systems worldwide, particularly cancer care. Because the actual implications of these changes on gynecological oncology healthcare are still unclear, we aim to evaluate the impact of this pandemic on the diagnosis and management of gynecological cancer. Materials and Methods: This is a single-center retrospective observational study, including patients diagnosed with gynecological malignancies between January 2019 and December 2021. Patients were included into three groups based on the timing of cancer diagnosis: pre-pandemic (2019), pandemic with high restrictions (2020) and pandemic recovery (2021). Results: Overall, 234 patients were diagnosed with gynecological cancer during the period of study. A decrease in the number of newly diagnosed cervical cancers and other rare tumors (leiomyosarcoma, invasive hydatidiform mole) was apparent in 2020. Some aggressive histological types of endometrial and ovarian cancer were more commonly diagnosed in the pandemic recovery group (p < 0.05), although no differences were demonstrated concerning tumor staging in all gynecological cancers. The median time between the first multidisciplinary team meeting and the treatment initiation was higher after the COVID-19 pandemic in endometrial cancer (23.0 vs. 34.0 vs. 36.0 days, p < 0.05). Patients with ovarian cancer were more frequently proposed for neoadjuvant therapy in 2020 compared to the other periods (33.3% vs. 55.0% vs. 10.0% p < 0.05). A significant reduction in the laparoscopic approach was observed during 2020 in endometrial cancer (32.1% vs. 14.3% vs. 36.4%, p < 0.05). No significant differences were registered regarding median hospitalization days or intra- and post-operative complications between these periods. Conclusions: The COVID-19 pandemic had a significant impact on the diagnosis and management of most gynecological malignancies, namely, on time to first treatment, chosen oncological therapies and surgical approaches. These results suggest important clinical and healthcare implications that should be addressed in future prospective studies.

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Objective To compare laparoscopy with laparotomy for surgical staging of endometrial cancer. Methods A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test. Results A total of 162 patients were analyzed. One-hundred and thirty eight patients met the inclusion criteria, 41 of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed. Conclusion Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.

BackgroundThe preparation of antineoplastic agents is a responsibility of the hospital pharmacy and is usually performed at a centralised preparation unit (CPU) to enable better protection for the staff and better safety for the patient. The CPUs have led to standardisation of techniques, implementation of a quality system and also a better use of antineoplastic agents. Those agents are prepared at a vertical laminar flow hood and some of the drugs, especially innovative treatments, have very high costs with significant financial impact for the hospital budget and the National Health System. In an attempt to minimise costs, we have established, among other organisational measures, specific days for the preparation of some of those drugs.PurposeTo evaluate the financial impact associated with the definition of specific days for the preparation of some antineoplastic and immunomodulating drugs at the hospital pharmacy CPU.Material and methodsThis prospective, observational and descriptive study took place during May 2017. The drugs included in the study were: bortezomib, liposomal doxorubicin (DLP), bevacizumab, trastuzumab pemetrexed, nivolumab and cetuximab. We took into account the real and the expected costs for each preparation of these drugs, as well as the savings per day and drug, as a result of the spared. We used the Microsoft Excel 7.0 program to collect and analyse data.ResultsBortezomib (€5.360) and bevacizumab (€2.194) were the drugs with the highest impact in total cost savings, with a 24% reduction in the expected costs. For nivolumab the saving was €3.700 (-6%), trastuzumab €2.440 (-8%), DLP €1.600 (-14%), pemetrexed €704 (-7%) and cetuximab €165 (-2. 5%). In one month the saving was €16.163, which represents an 11% reduction in this medicines’ expected costs. According to this data, we estimate an €193.956 annual saving.ConclusionThe definition of specific days for the preparation of high-cost treatments is a strategy with a significant impact on waste reduction as well as on human and financial resources’ management. An annual saving perspective of approximately €2 00 000 obtained from a single procedural change applied to only seven drugs proved to be highly impactful, especially for its potential use on other drugs and its impact on economical sustainability.No conflict of interest

BackgroundNew antiviral drugs used in hepatitis C treatment show better efficacy and safety. However, their adverse events (AEs) and interaction (IT) profiles require careful review of all concomitant therapy and patient education. As medication experts and due to their privileged access to patients, hospital pharmacists can monitor concomitant therapy as well as AE incidences, preventing potential risks and contributing to a reduction in morbidity and mortality associated with treatment.PurposeAnalysis of AE incidences and IT, with concomitant therapy, of ledipasvir/sofosbuvir (LDV/SOF), with or without ribavirin (RBV), in patients with chronic hepatitis C virus infection treated at Hospital Prof Doutor Fernando Fonseca (HFF).Material and methodsIn January 2015, we began a prospective study in patients receiving LDV/SOF, with or without RBV. At every visit to the HFF ambulatory pharmacy department, patients were interviewed during their pharmaceutical appointment and all AEs were identified as well as all concomitant therapy. Patients rated the AEs as mild, moderate or severe. IT profile was evaluated at Micromedex and hepdruginteractions.org. Clinical records were also considered (Soarian, Siemens). Data were analysed in Excel, Microsoft and will be collected until January 2016.ResultsOf all 107 patients presently under therapy, 44% were polymedicated. Among those, 79% had drug-drug IT potential and maintained treatment after clinical review and 21% had changes in concomitant therapy. IT with sporadic therapy was also detected in 15% of patients. Treatment related AEs occurred in 73% of all patients. Among patients receiving LDV/SOF, 53% had AEs not described in the Summary of Product Characteristics, namely visual disturbances (26%), nausea (14%), asthenia (8%), dizziness, insomnia, loss of appetites and abdominal pain (6%). In patients receiving RBV, 8% confirmed appetite increase. Among all non-described AEs, 16% were rated as severe.ConclusionPolymedication is a potential risk to ITs which will have a negative impact on efficacy and safety treatment outcomes. To date, among 210 pharmacy appointments, there were 62 (30%) interventions, all of them accepted. Active pharmacovigilance will allow pharmacists to act immediately on problem recognition.References and/or AcknowledgementsAlqahtani, et al. Safety and tolerability ledipasvir/sofosbuvir with and without ribavirin in patients with chronic hepatitis C virus genotype 1 infection: Analysis of phase III ION trials. Hepatology 2015:6:25-30No conflict of interest.