Gynaecologic cancer care during COVID‐19 pandemic in India: a social media survey

Abstract

Background: Health care services across the globe are undergoing a major transformation to combat the coronavirus disease 2019 (COVID-19) pandemic. Regardless of the strength of health care infrastructure across different economies, all countries are diverting their resources toward care for COVID-19 patients. Aim: The aim of this survey was to evaluate the pattern of care of gynaecologic cancers in a developing country during the COVID-19 pandemic. Methods: An anonymous survey consisting of 20 questions intended for the gynaecologic cancer care providers with emphasis on their current practice and approach to their patients was distributed online via social media from April 30 to May 31, 2020. Basic descriptive statistics were applied. Results: Among a total of 61 respondents, 63.9% were gynaecologic oncologists, 18.0% were radiation oncologists and 18.0% were medical oncologists. Majority, that is, 95.1% health care professionals felt that COVID-19 pandemic has had a significant change on their practice pattern and 56.2% practitioners had stopped registering new cases of cancer. In 75.4% centers surgery was being done for gynaecologic cancer cases and among them 60.8% were doing surgery only for cases requiring immediate intervention. Among the centers providing chemotherapy, 39.1% had switched to oral drugs. Among the centers providing radiation, 40.9% were providing radiation to cases based on their type and urgency and 9.0% had implemented hypofractionation. In early stage low risk cases, majority, that is, 34.0% centers were managing as before. In early stage high-risk cases, 32.6% centers were managing as before. In advanced stage endometrial cancer cases, 28.8% had postponed any treatment and 28.8% administered chemotherapy. In early stage, epithelial ovarian cancer 65.9% centers were performing complete staging of the disease. In advanced stage epithelial ovarian cancer, 65.9% centers preferred biopsy followed by neoadjuvant chemotherapy and 11.3% centers performed primary debulking surgery. In cases of interval debulking surgery, 73.3% centers deferred surgery till all six cycles of chemotherapy was completed. In cases of recurrent ovarian cancer amenable for secondary debulking surgery, 38.6% preferred chemotherapy. In early stage cervical cancer, surgical treatment was provided in 46.5% centers. In locally advanced cervical The copyright line for this article was changed on 23 September 2020 after original online publication.

The worldwide impact of COVID-19 on cancer care: A meta-analysis of surveys published after the first wave of the pandemic

“…Overall, 65% [c.i. 53%-75%, I 2 98%, number of studies: 14 ( 27 – 29 , 36 – 38 , 42 – 44 )] of studies reported some modification of the treatment regimens or surgical interventions. The moderator variable which alone explained the most heterogeneity was the geographical area in which the study was conducted (n=9, R 2 31%, I 2 96.9%, p-value for the test of moderators in meta-regression=0.02).…”

Gynecologic radiation therapy in low and middle income countries during the COVID-19 pandemic

“…A survey of providers across India (61 total respondents, 63.9% gynecologic oncologists, 18% radiation oncologists) noted that 95% of respondents felt that COVID-19 had modified their patterns of care for patients with gynecologic cancer. Additionally, 40.9% of respondents said they provided radiation to cases based on an urgency scale, and 9% reported having implemented hypofractionation in response to the pandemic 18…”

“…Additionally, 40.9% of respondents said they provided radiation to cases based on an urgency scale, and 9% reported having implemented hypofractionation in response to the pandemic. 18…”

COVID‐19 infection and its consequences among surgical oncology patients: A systematic analysis, meta‐analysis and meta‐regression

“…The available published data on, international recommendations for, and global experience with infections in cancer patients may help overcome the challenges described above 2,12–14 . Nevertheless, our understanding of the COVID‐19 pandemic is evolving, and the oncologic surgery workflow must be revisited, updated, and optimized as a result to account for the range of institutional, local, and national conditions during the pandemic.…”

“…The available published data on, international recommendations for, and global experience with infections in cancer patients may help overcome the challenges described above. 2 , 12 , 13 , 14 Nevertheless, our understanding of the COVID‐19 pandemic is evolving, and the oncologic surgery workflow must be revisited, updated, and optimized as a result to account for the range of institutional, local, and national conditions during the pandemic. Therefore in this systematic review, meta‐analysis, and meta‐regression, we analyzed the measurable reported outcomes and identified potential predictors of poor outcome in cancer patients who had oncologic surgery during the COVID‐19 pandemic.…”