Considerations for the Care of Women with Gynecological Cancers during the COVID-19 Pandemic

Abstract

Delivering care for patients with cancer during the COVID-19 pandemic can pose a significant challenge, given the fact that cancer patients face a higher risk of morbidity and mortality from the infection. Outcomes in gynecological cancers are heavily stage-dependent, ranging from 5-year survival 95% in early stage to less than 15% in advanced stages. Early diagnosis and timely treatment are therefore of the utmost importance, but they should be balanced, considering the availability of local expertise and resources and the local pandemic status. This article outlines the management guidelines for the care of women with gynecological malignancies during the COVID-19 pandemic.

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

“…46 Women with early stage, low risk endometrial cancer can be allowed a delay of 6 to 8 weeks for starting treatment. 42,47 Such patients can be treated with oral hormonal therapy or insertion of LNG-IUD system to control disease till definitive treatment. Laparoscopic staging surgery with peritoneal wash cytology, extrafascial hysterectomy with or without salpingo-oopherectomy, and lymphadenectomy can be considered with efficient filtering and smoke evacuation systems to prevent contamination of operating room with pneumoperitoneum induced aerosols.…”

“…In those who have completed 3 cycles, a further 3 cycles can be administered before attempting interval cytoreductive surgery. 46,47 Low risk surgeries like completion surgery following incidental diagnosis after ovarian cystectomy or oophorectomy, and risk reducing salpingo-oopherectomy are considered low priority disease and may be deferred. For hormone responsive tumours like low grade serous and endometrial cancers, oral hormonal therapy can be instituted.…”

“… 42 Hormone receptor positive tumours may benefit from hormonal therapy and radiation can be deferred. 47 Where possible, molecular classification should be performed to exclude patients who may not require adjuvant therapy. Immunotherapy should be started with caution in patients in whom tumours show microsatellite instability or POLE mutations.…”

“…In those who have completed 3 cycles, a further 3 cycles can be administered before attempting interval cytoreductive surgery. 46 , 47 …”

“… 46 The prudent treatment of these rare gynecological cancers with surgery or chemotherapy/radiotherapy depending on patients’ age, comorbidities, stage of disease, risk factors etc has been advocated by other studies as well. 47 …”