2022-RA-1057-ESGO Outcomes of gynaecological cancer surgery during the covid-19 pandemic: results from the international, multicenter, prospective covidsurg-gynaecological cancer study

Abstract

as wait times have increased during the COVID pandemic. In this patient preference study we investigated 1)how patients experience wait time; 2)what wait time is acceptable; 3)how it impacts quality of life. Methodology Mixed methods study design; combining a qualitative interview study with a questionnaire among women with gynecological cancer. We performed semi-structured interviews with 20 women about their experiences with and preferences regarding wait time. Using thematic analysis we found factors that impact wait time acceptability and based on this developed a questionnaire. The questionnaire was administered to 100 women who had undergone surgery for gynecological cancer in two tertiary hospitals in the Netherlands. Results Wait time between first appointment and surgery was more than 4 weeks for 61% of patients. Wait time was considered too long by 77% of these patients compared to 39% of patients who waited less than 4 weeks (p=0.01). 31% of patients scored above the threshold for either anxiety or depression on the Hospital Anxiety and Depression Scale (HADS), 63% of patients had sleeping problems and 37% of patients experienced pain frequently or most of the time. Patients spent less time on working (38%) and exercise (46%) and more time on time on relaxation (38%), with friends (27%) and educating themselves on their illness (40%). Conclusion Waiting for surgery is often stressful for gynecological oncology patients. Waiting over 4 weeks for surgery is considered too long by most patients. Patients reduced time working and exercising and increased time finding information on their illness. This study provides directions on how to improve quality of care the weeks before surgery from the patient's perspective.

Impact of the COVID-19 Pandemic on Diagnosis and Management of Gynecological Cancer: A Single-Center Analysis

“…One of the most impactful measures was the implementation of priority levels for treatment selection in order to reduce hospital admissions and elective surgeries. This led to significant treatment modifications, particularly to the delay, change and cancelation of surgical plans, or even disruption to usual first-line surgical approaches [14,31,32]. Moreover, in cases of more advanced or relapsed disease, in which treatment is intended to be more life-prolonging and not curative, international guidelines recommended that surgery should be delayed or replaced by systemic or palliative options that could be associated with poorer and less favorable outcomes [32].…”

“…This led to significant treatment modifications, particularly to the delay, change and cancelation of surgical plans, or even disruption to usual first-line surgical approaches [14,31,32]. Moreover, in cases of more advanced or relapsed disease, in which treatment is intended to be more life-prolonging and not curative, international guidelines recommended that surgery should be delayed or replaced by systemic or palliative options that could be associated with poorer and less favorable outcomes [32]. These facts were documented by a multicenter prospective cohort study including 3973 cancer patients, in which 1 in 5 patients with canceled surgeries had disease progression, and 1 in 20 died within 3 months after the multidisciplinary decisions [32].…”

What role does PDL1 play in EMT changes in tumors and fibrosis?

“…The fibrotic effect of PDL1 in IPF arises from intricate cellular interactions and signaling pathways, with the following mechanisms assuming paramount significance (Figure 4): firstly, overexpression of PDL1 in lung fibroblasts exerts resistance to myoblast apoptosis and eludes macrophage phagocytosis via the inhibition of p53 pathway or activation of FAK pathway. Consequently, excessive myoblast proliferation ensues, instigating IPF development (85)(86)(87); secondly, PDL1 mediates the transition of pulmonary fibroblasts into myofibroblasts and instigates EMT induction via TGF-b, facilitated by the Smad3 and b-catenin signaling pathways, thereby promoting fibrosis (88, 89); thirdly, upregulation of PDL1 in pulmonary fibroblasts hampers autophagy-induced myofibroblast proliferation and ECM deposition, ultimately leading to pulmonary fibrosis. Overexpression of PDL1 can inhibit autophagy of fibrosis-related cells through the PI3K/AKT/ mTOR signal pathway, up regulate TGF-b and fibrosis-related factor a-SMA (90-92); fourthly, elevated PDL1 expression in pulmonary fibroblasts impedes adaptive immunity, fostering pulmonary fibrosis.…”

Best original research presented at the 23rd European Congress on Gynaecological Oncology—Best of ESGO 2022

“…A multicenter, international prospective cohort study evaluating the outcomes of gynecological cancer surgery during the COVID-19 pandemic was presented by Elaine Leung 36. This study included 3973 patients (52 countries; seven world regions; 27% from low- and middle-income countries).…”