The COVID-19 Pandemic and Implications for Gynaecologic Cancer Care

Abstract

Purpose The impact of the COVID-19 pandemic on world healthcare system and economy is unprecedented. Currently routine surgical procedures are at a halt globally, but whether one can delay cancer procedures remains an ethical issue, and still there is no clarity on how women with gynaecological cancers should be managed in these critical times. Methods Currently available literature on impact of COVID-19 on cancer was reviewed with special reference to its applicability to the Indian context. Results Cancer cases are more susceptible for COVID-19 infection and rapid deterioration if they get infected. A tumour board should plan their management with a ''do no harm'' approach as the guiding principle. Teleconsultation may be used to advise patients for therapy and symptom control measures, as well as to advise new patients regarding diagnostic tests. Surgical decision making may be stratified into three categories: patients with low (not life threatening) or intermediate (potential for future morbidity or mortality) acuity may be delayed; those with high acuity may be taken up for planned therapy after explaining the risks. Assessment of the severity of disease, comorbid conditions, and logistic challenges, along with COVID census in their area are important variables for informed and individualized decision making. Safety of healthcare personnel needs to be ensured at the same time.Conclusion Currently available evidence is limited by small sample size, and full impact of this pandemic on cancer is yet to be seen. However, cancer care needs to be individualized taking all variables into consideration.

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

“…• The gynaecological oncology team should be divided into three groups, with each working for 1 week at a time. This will ensure that in the case of any exposure, only members of the affected group will be isolated/quarantined, whereas the other groups will continue to render uninterrupted services [15]. • All patients and their caregivers should be provided with the unit's telephone number to enable them to contact any designated member of the healthcare team when necessary.…”

“…The basic principle is to prioritise intervention for oncological emergencies, initiate treatment for aggressive or advanced-stage disease and reasonably postpone intervention for benign, pre-invasive or early-stage low-grade malignancy after informed consent. To carry out surgical procedures in an orderly and safe manner, an acuity scale is suggested to guide gynaecological oncologists whether to postpone or perform surgical procedures during the COVID-19 pandemic [15,17].…”

“…• The first consideration should be given to surgery that is unlikely to require adjuvant treatment [15].…”

For the life after COVID-19 pandemic – A gynecologist’s call to action

“…5 Gynecological malignancies would also further aggravate in view of delay in the diagnosis, surgical treatments, initiation of neo-adjuvant or adjuvant chemotherapy and immunotherapy. Rapid dissemination of aggressive tumors and upstaged disease with added debilitated conditions and infectious morbidities pose a real threat [8].…”

“…vi Develop hospital software to book online appointments or telephonically so as to avoid post pandemic overcrowding and resurgence of the infection. vii Gynaecological cancer should be managed as per guidelines [8,9] The most salient role is to be played by the clinicians in the crisis. Few institutions do provide on call doctor facilities but the prevailing emergency and quarantine measures for the exposed doctors themselves, it would be a hard task to ensure that the purpose would be served.…”