COVID-19 and Gynecological Oncology: What happened to healthcare practitioners around the world?

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The COVID-19 pandemic shocked the world.

It affected and will probably modify both our lives and the way we treat cancer patients.  The pandemic spread in different ways between countries. The resources required to properly face the pandemic were not the same across the world. This affected the safety of medical personnel and patients alike – up to one quarter of patients did not receive tests to rule-out COVID-19 infection before treatment.

The entire medical community were required to change cancer patient management. Generally there was an effort towards reducing hospital visits, implementing telemedicine and not-in-person consultations. There was an eager increase in the use of digital resources to stay up to date and in contact, personally and also among healthcare practitioners.

Social media has become a very useful tool to connect the medical community. Through this digital phenomena, it  was possible to analyse what was happening across the world, in a fast and reliable way. We surveyed the medical community treating gynaecologic cancers via social media (including gynaecologists, gynaecologic oncologists, medical oncologists, radiation oncologists, surgical oncologists and so) to evaluate the impact that COVID-19 had on daily practice. The results have been published in the International Journal of Gynaecological Cancers.

Respondents were from 49 different countries covering all continents. Luckily, during the world lock-down, two thirds of physician had the chance to work in a COVID-free ward. Nevertheless nearly one third of physicians had to change chemotherapeutic schedules or indications, noticed an increase of indications for radiotherapy and did not perform laparoscopies.  Globally there was an agreement in deferring or modifying treatments in patients suffering from COVID-19 infection.

In early stage endometrial cancer treatment, there was an increase use of hormone therapy, which is usually performed fertility sparing purposes. In newly diagnosed advanced ovarian cancer, there was a great reduction in surgical approaches in favour of chemotherapy. Whether or not this will “solve” the  ongoing discussion on the best sequence of treatment (primary surgery followed by chemotherapy vs neoadjuvant chemotherapy followed by interval debulking surgery) is still a matter of debate. The same was also the case for relapsed ovarian cancer (surgery vs chemotherapy).

Patients with early stage cervical cancer were still considered for surgical treatment, but deferring surgery was taken into account. Reducing invasiveness without compromising staging strategies was also a point of interest – sentinel node procedures where the most commonly used for nodal staging in cervical, endometrial and vulvar cancer. There was a widening of indications for radiation therapy in advanced cervical cancers, with hypofractionation of doses to reduce hospital accesses.

Evidently, the COVID-19 pandemic has prompted the medical community treating gynaecologic cancer patients to explore “different” ways for treating these women. Reduction of hospital visits will probably be taken into account for the future, favouring telemedicine and teleconsultation as a legacy of the pandemic. Prioritization of treatments according to pathology will also be a thing to keep in mind if oncological outcomes (survival) are not be compromised as with continue to face this global pandemic.


Paper:

  1. Martinelli, Fabio and Garbi, Annalisa. Change in practice in gynecologic oncology during the COVID-19 pandemic: a social media survey. International Journal of Gynecological Cancer. Volume 30, Issue 8. http://dx.doi.org/10.1136/ijgc-2020-001585 

 

 

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About Author

Fabio Martinelli

Fabio Martinelli, MD is an attending physician in the Department of Gynecologic Oncology at IRCCS Foundation - National Cancer Institute of Milan –Italy since 2012, when he graduated residency in Obstetrics and Gynecology from the University of Milan. During his training attended at The University of Texas MD Anderson Cancer Center - Gynecologic Oncology and Reproductive Medicine Department, at the Department of Gynaecology and Gynaecological Oncology of Kliniken-Essen-Mitte and at the Universidad Autonoma of Madrid.

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