COVID-19 Pandemic Impact on Surgical Treatment Methods for Early-Stage Cervical Cancer: A Population-Based Study in Romania

Abstract

Being one of the most common malignancies in young women, cervical cancer is frequently successfully screened around the world. Early detection enables for an important number of curative options that allow for more than 90% of patients to survive more than three years without cancer relapse. Unfortunately, the COVID-19 pandemic put tremendous pressure on healthcare systems and access to cancer care, determining us to develop a study on the influence the pandemic had on surgical care of cervical cancer, and to assess changes in its management and outcomes. A retrospective study design allowed us to compare cervical cancer trends of the last 48 months of the pre-pandemic period with the first 24 months during the COVID-19 pandemic, using the database from the Timis County Emergency Clinical Hospital. New cases of cervical cancer presented to our clinic in more advanced stages (34.6% cases of FIGO stage III during the pandemic vs. 22.4% before the pandemic, p-value = 0.047). These patients faced significantly more changes in treatment plans, postponed surgeries, and postponed radio-chemotherapy treatment. From the full cohort of cervical cancer patients, 160 were early stages eligible for curative intervention who completed a three-year follow-up period. The disease-free survival and overall survival were not influenced by the surgical treatment of choice, or by the SARS-CoV-2 infection (log-rank p-value = 0.449, respectively log-rank p-value = 0.608). The individual risk factors identified for the three-year mortality risk were independent of the SARS-CoV-2 infection and treatment changes during the COVID-19 pandemic. We observed significantly fewer cases of cervical cancer diagnosed per year during the first 24 months of the COVID-19 pandemic, blaming the changes in healthcare system regulations that failed to offer the same conditions as before the pandemic. Even though we did not observe significant changes in disease-free survival of early-stage cervical cancers, we expect the excess of cases diagnosed in later stages to have lower survival rates, imposing the healthcare systems to consider different strategies for these patients while the pandemic is still ongoing.

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

“…The World Health Organization (WHO) identified a cluster of respiratory illness cases with an unknown origin in Wuhan, China, in December 2019 [ 1 ]. The respiratory illness, which was subsequently called ‘Coronavirus Disease 2019’ (COVID-19), spread rapidly to neighboring states and has turned into a worldwide pandemic [ 2 , 3 ]. The condition is caused by the RNA virus “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) and is spread mostly via respiratory droplets and intimate contact with an infected person [ 4 , 5 ].…”

Excess Mortality among Physicians and Dentists during COVID-19 in Italy: A Cross-Sectional Study Related to a High-Risk Territory

“…Therefore, it is correct to state that the area of afference of the physicians and dentists included in this study had one of the highest rates of diffusion and severity of COVID-19. The excess mortality could also have been influenced by the overload of the healthcare system, [ 36 , 50 ] which could have led to a reduction in the level of care for both patients with COVID-19 and those with other acute or chronic diseases [ 9 , 51 , 52 , 53 ].…”

COVID-19 as a catalyst for reimagining cervical cancer prevention

“…Diagnoses of all cancers were reduced during the COVID-19 pandemic relative to pre-pandemic rates, resulting in a backlog of diagnoses ( Eskander et al, 2022 ). A study in 2022 in Romania reported presentation of cervical cancer at more advanced stages during the pandemic, which accompanied significant changes in treatment courses due to interruptions in surgical and radiation services ( Popescu et al, 2022 ). Recent modeling studies from the United Kingdom and United States estimate that the burden of cervical cancer will increase regardless of the length of time taken to catch up on missed screening, diagnosis and treatment due to COVID-19 ( Castanon et al, 2021b ; Burger et al, 2021 ).…”