Impact of the COVID-19 epidemic at a high-volume facility in gynecological oncology in Tokyo, Japan: a single-center experience

Abstract

Background The number of cases of novel coronavirus disease 2019 (COVID-19) in Japan have risen since the first case was reported on January 24, 2020, and 6225 infections have been reported as of June 30, 2020. On April 8, 2020, our hospital began screening patients via pre-admission reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and chest computed tomography (CT). Although no patients exhibited apparent pneumonia, treatment delay or changes in treatment plans were required for a few patients based on the results of screening tests. During an emerging infectious disease pandemic, the likelihood of being infected, as well as the disease itself, affects clinical decision making in several ways. We summarized and presented our experience. Case presentation After the introduction of pre-admission screening, RT-PCR and CT were performed in 200 and 76 patients, respectively, as of June 30, 2020. The treatment of five patients, including two patients with cervical cancer, two patients with ovarian tumors, and one patient with ovarian cancer, was affected by the results. Two asymptomatic RT-PCR-positive patients did not develop COVID-19, but their treatment was delayed until the confirmation of negative results. The other three patients were RT-PCR-negative, but abnormal CT findings suggested the possibility of COVID-19, which delayed treatment. The patients receiving first-line preoperative chemotherapy for ovarian cancer had clinically evident exacerbations because of the treatment delay. Conclusion During the epidemic phase of an emerging infectious disease, we found that COVID-19 has several other effects besides its incidence. The postponing treatment was the most common, therefore, treatment of ovarian tumors and ovarian cancer was considered to be the most likely to be affected among gynecological diseases. Protocols that allow for easy over-diagnosis can be disadvantageous, mainly because of treatment delays, and therefore, the protocols must be developed in light of the local infection situation.

Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow‑up

“…Of particular note is that a relatively small percentage of patients in the present cohort appear to have had gynecologic follow-up within the most recent period. This finding temporally coincides with the global COVID-19 pandemic, during which there has been a worldwide drop in cervical screening ( 37 – 41 ) with major deleterious consequences vis-à-vis cervical cancer incidence, treatment delay and mortality ( 39 , 42 , 43 ). During the 1st wave of the COVID pandemic, nearly 200 000 cervical screening appointments were cancelled in Stockholm ( 44 ).…”

Age, margin status, high‑risk human papillomavirus and cytology independently predict recurrent high‑grade cervical intraepithelial neoplasia up to 6 years after treatment

“…Concordantly, a number of reports worldwide indicate a precipitous decline in cervical screening ( 43 – 47 ). The actual and potential consequences of the COVID-19 pandemic vis-à-vis increased cervical cancer incidence, treatment delay and mortality have been underscored ( 45 , 48 , 49 ). Home self-sampling for HPV is widely endorsed as the key strategy to avoid these pandemic-related, adverse consequences ( 42 , 44 , 47 , 50 – 53 ).…”

Qualitative Interdisciplinary Learning Reviews of Non-COVID-19 Patients’ Journeys During the COVID-19 Pandemic

“…The opportunities for improvement identified in the ILR process were consistent with the challenges faced by healthcare workers and systems around the world in our literature review. For example, the need to first establish patients’ COVID-19 status and patients’ reluctance to seek medical care due to concerns for COVID-19 infection delayed and interrupted the usual flow of care [ 1 - 3 , 10 - 11 ]. Social distancing and visitation limitations induced psychological burdens on patients and families and impacted the recovery process [ 12 - 13 ].…”

“…One of the concerns during the pandemic was the delayed provision of appropriate care due to the need to first establish patients’ COVID-19 status, resulting in an increased wait-time for definitive medical or surgical treatments [ 1 - 5 ]. Delay of care was also associated with the public’s reluctance to seek medical care due to concerns about contracting COVID-19 in medical settings.…”