Covid‐19: What is the best approach in gynecological oncology patient management during the coronavirus pandemic?

Abstract

Coronavirus (COVID-19) infection is a new major concern and a global emergency in almost all countries worldwide; due to the higher sensibility of cancer patients, they are more susceptible to severe and fatal infections, being nearly 10 times more likely than in healthy individuals infected with this virus. Although the aggressive nature of a cancer is a matter of concern, our exact role as oncologists in this time of restricted resources is not fully clarified. Regarding some consensus recommendation for postponing surgery, there is still an essential need for a single approved protocol regarding each type of malignancy. Iran, as one of the first involved countries in this crisis in Asia, which also has a high prevalence of gynecological malignancies, will certainly require an individualized decision-making schedule based on the most accepted global consensus opinion. Considering our restricted health system resources, herein we tried to introduce a logical gynecologic cancer management protocol based on the stage and survival expectancy of each tumor, along with reviewing all recent recommendations. The limited statistics published in this short period of time have obliged us to mainly focus on expert opinions, and the individualized clinical judgments should be agreed upon by multidisciplinary tumor board consensus. In conclusion, the COVID-19 pandemic overshadows all aspects of medicine, and decision making in gynecological oncology patients requires precise and appropriate judgment based on the available local resources.

Impact of COVID-19 on management of urogynaecology patients: a rapid review of the literature

“…Given the rapid evolution of evidence, recommendations, policies and clinical management adaptations, a rapid review on the current evidence and recommendations is highly warranted. Since the COVID-19 pandemic was declared, several publications have appeared providing narrative reviews in order to bring all the relevant information from the guidelines together in one document, to support patient care [8][9][10]. These studies summarise and review published guidelines, original studies, consensus statements, opinions and comments in peerreviewed journals, and professional organisations and societies.…”

Effects of COVID-19 fear and anxiety on attitudes towards complementary and alternative medicine use in women with gynecological cancer during the COVID-19 pandemic

“…Women who experience fear and anxiety about COVID-19 infection use CAM methods to fight the disease and increase immunity and hope. It is thought that reduction in hospital visits and interruption of treatment, due to the pandemic [1] , [6] , [11] , caused patients with gynecological cancer to opt for CAM methods to help control their conditions. In the literature, no similar studies on this subject have been found.…”

“…COVID-19 is thought to be especially stressful for cancer patients [6] , [8] , [9] , [10] . The literature shows that cancer patients have a higher risk of death due to COVID-19; the level of admission to intensive care units is high; and they need more invasive ventilation, compared to non-cancer patients [3] , [11] . During the pandemic, cancer patients cancelled or postponed elective and non-emergency cancer surgeries and medical tests due to concerns over these negative health outcomes, and changes in treatment protocols were made (e.g., longer intervals between chemotherapy cycles) [1] , [2] , [11] .…”

“…The literature shows that cancer patients have a higher risk of death due to COVID-19; the level of admission to intensive care units is high; and they need more invasive ventilation, compared to non-cancer patients [3] , [11] . During the pandemic, cancer patients cancelled or postponed elective and non-emergency cancer surgeries and medical tests due to concerns over these negative health outcomes, and changes in treatment protocols were made (e.g., longer intervals between chemotherapy cycles) [1] , [2] , [11] . These delays and changes in cancer care have increased the fear and anxiety levels of cancer patients who have difficulty reaching healthcare personnel [2] , [4] , [6] , [10] , [12] , [13] and have adversely affected patients’ quality of life and access to healthcare services [4] , [10] , [12] , [13] .…”

Nationwide Survey of German Outpatient Gynecologic Oncology Practices during the Coronavirus Disease 2019 Pandemic: Reactions to the First Wave and Future Perspectives

“…Therefore, many medical professional societies quickly released updated guidelines to support clinicians (the SGO, the British Gynecologic Oncology Society, etc.) [ 23 ].…”