Management of patients with gynecological cancers during the COVID-19 pandemic

Dessai, Sampada; Nachankar, A.; Kataria, Pritam; Abyankar, Anuja

doi:10.4103/crst.crst_124_20

Cited by 13 publications

(17 citation statements)

References 45 publications

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“…While surgery may be possible if there is no disruption of routine clinical services, delay in surgery may be inevitable in many centres because of diversion of healthcare resources towards COVID-19 cases. There is some evidence that a delay in surgery of more than 6 weeks was associated with the worst overall survival for type 1 endometrial cancers, especially stage 1 and 2 [8]. Keeping this in mind would be helpful when the time-lines for surgery are altered.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and its impact on gynaecologic oncology practice in India—results of a nationwide survey

Subbian¹,

Kaur²,

Patel³

et al. 2020

ecancer

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The COVID-19 pandemic sweeping across the world has caused major disruptions in healthcare delivery and practice. A survey was conducted to assess the changes in the care of gynaecologic oncology patients in India. Methods: An online survey enquiring about the patient volumes and surgical load, and changes in practice protocols for endometrial, ovarian, cervical and vulval cancers was conducted in May, 2020. Results: The total number of responses received was 153. Barring duplicates, 148 were analysed. There was a significant drop in gynaecologic oncology patients attending government hospitals as compared to the non-government sector. The drop was not significantly different in areas having low versus high COVID-19 case volumes. The treatment of endometrial cancers remained the same although there was a marked shift from minimal access surgery to conventional surgery. Advanced ovarian cancer was mostly managed by neoadjuvant chemotherapy. Cervical and vulval cancer management remained the same, but radiotherapy protocols were modified by most. Conclusion: Based on clinician responses, it appears that most practices across India have suffered a fall in patient volumes. The responses from government sectors point towards a bigger hit in this segment of practice. While the management of endometrial cancers and cervical cancers was mostly unchanged, most cases of advanced ovarian cancer received neoadjuvant chemotherapy. Cervical cancer, when managed by chemoradiation, was likely to have altered radiation schedules.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and its impact on gynaecologic oncology practice in India—results of a nationwide survey

Subbian¹,

Kaur²,

Patel³

et al. 2020

ecancer

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“…• Gynaecological oncologists should adopt greater utilisation of non-surgical options including radiotherapy when available or chemotherapy to delay major resection surgery until there is greater availability of services, such as ICU support [6]. • The use of granulocyte-colony-stimulating factor prophylaxis, where available and affordable, should be more liberal than usual to avoid the risk and decrease the duration of immunosuppression [14]. • In the case of patients developing pneumonia during treatment, COVID-19 must be considered as one of the differentials.…”

Section: General Principlesmentioning

confidence: 99%

“…• All healthcare workers in the gynaecological oncology team should wear appropriate personal protective equipment (PPE) (see Table 1) [14]. • The gynaecological oncology team should be divided into three groups, with each working for 1 week at a time.…”

Section: General Principlesmentioning

confidence: 99%

“…For advanced disease, neoadjuvant therapy should be given, and interval cytoreduction should be performed after 3-6 cycles. If recurrent cases are symptomatic, only then systemic therapy should be offered [14]. Single-agent therapy or metronomic combination should be preferred [8,23].…”

Section: Ovarian Cancermentioning

confidence: 99%

“…For intermediate and high risks (type 2 histology and grade 2/3), consider performing hysterectomy with salpingo-oophorectomy, omentectomy and pelvic lymph node dissection. Adjuvant chemoradiation can be deferred in high-risk cases and omitted for patients with low and intermediate risk [14]. In advanced disease, either progesterone or radical radiation with brachytherapy can be administered.…”

Section: Endometrial Cancermentioning

confidence: 99%

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Good clinical practice advice for the management of patients with gynaecological cancer during the COVID-19 pandemic in Nigeria and other resource-constrained countries

Okunade¹,

Okunowo²,

Ohazurike³

et al. 2020

ecancer

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The impact of the COVID-19 pandemic on healthcare services in settings with underresourced health systems such as that of Nigeria is likely to be substantial in the coming months. The gynaecological oncology services still need to be prioritised as an essential core health service. There are increasing concerns from both physicians and patients regarding how to manage patients diagnosed with cancer during this pandemic as evidence suggests a substantial increase in the risk of COVID-19-related deaths amongst patients with cancer. However, we recognise that despite this great challenge, we must continue to provide the highest quality of care to the patients, whereas, at the same time, ensure adequate safety not only for the patients and their families but also for the entire oncology team. We advocate that due to the widespread travel restrictions and inability to refer patients for the highest level of care at this period, centres without radiotherapy facilities as seen in most resource-limited settings should always consider lower level care options such as the use of chemotherapy pending when there is a better access to these facilities. We, therefore, developed this good clinical practice advice to staff of the gynaecological oncology unit in the centre and other resource-constrained settings for the management of patients with gynaecological cancer during the COVID-19 pandemic.

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Management of Gynecologic Cancer During COVID-19 Pandemic: South Asian Perspective

Singh

Mishra

Jayraj³

et al. 2022

Cancer Control

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Management of gynecological cancers has suffered during the pandemic, partly due to lockdown and partly due to directing resources to manage COVID-19 patients. Modification of gynecological cancer management during this pandemic is recommended. Cervical cancer patients who present with stage IA1 disease can have a delay of up to 8 weeks for surgical treatment, considering the slow tumor growth rate. Women with stages IA2, IB1, IB2, IIA1 must undergo radical hysterectomy and lymphadenectomy within 6 to 8 weeks. In areas where surgical treatment is not available, patients should be referred for radiation therapy/areas with adequate surgical expertise. The surgical option is attractive for early cancers during the COVID era, as it involves a single visit compared to the multiple visits required for chemoradiation. The value of lymph node staging needs to be reconsidered. Neoadjuvant chemotherapy should be given preference over primary cytoreductive surgery for advanced ovarian cancers. Surgeries, which demand extended surgical time such as Hyperthermic Intraperitoneal Chemotherapy and pelvic exenterations, should be avoided during this pandemic. For patients scheduled for interval surgery after two or three neoadjuvant cycles, six cycles of chemotherapy should be considered before surgery is performed. For early-stage, low-grade endometrial cancer, consideration should be given to medical management until surgery is possible. The above recommendations have been made keeping in mind the geography, patient load, and availability of resources available to health care providers from southeast Asia. They might not be applicable globally and every practitioner should take call regarding patient’s management as per availability of resources and loco-regional circumstances. The implementation of recommended international guidelines for the management of gynecologic cancers should take precedence. Each modification to the standard approach should be approved by a multidisciplinary team depending on the condition of the patients and the locoregional circumstances.

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Management of patients with gynecological cancers during the COVID-19 pandemic

Cited by 13 publications

References 45 publications

COVID-19 and its impact on gynaecologic oncology practice in India—results of a nationwide survey

COVID-19 and its impact on gynaecologic oncology practice in India—results of a nationwide survey

Good clinical practice advice for the management of patients with gynaecological cancer during the COVID-19 pandemic in Nigeria and other resource-constrained countries

Management of Gynecologic Cancer During COVID-19 Pandemic: South Asian Perspective

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