Impact of the COVID-19 Pandemic on Diagnosis and Management of Gynecological Cancer: A Single-Center Analysis

Abstract

Background and Objectives: The COVID-19 pandemic impacted health systems worldwide, particularly cancer care. Because the actual implications of these changes on gynecological oncology healthcare are still unclear, we aim to evaluate the impact of this pandemic on the diagnosis and management of gynecological cancer. Materials and Methods: This is a single-center retrospective observational study, including patients diagnosed with gynecological malignancies between January 2019 and December 2021. Patients were included into three groups based on the timing of cancer diagnosis: pre-pandemic (2019), pandemic with high restrictions (2020) and pandemic recovery (2021). Results: Overall, 234 patients were diagnosed with gynecological cancer during the period of study. A decrease in the number of newly diagnosed cervical cancers and other rare tumors (leiomyosarcoma, invasive hydatidiform mole) was apparent in 2020. Some aggressive histological types of endometrial and ovarian cancer were more commonly diagnosed in the pandemic recovery group (p < 0.05), although no differences were demonstrated concerning tumor staging in all gynecological cancers. The median time between the first multidisciplinary team meeting and the treatment initiation was higher after the COVID-19 pandemic in endometrial cancer (23.0 vs. 34.0 vs. 36.0 days, p < 0.05). Patients with ovarian cancer were more frequently proposed for neoadjuvant therapy in 2020 compared to the other periods (33.3% vs. 55.0% vs. 10.0% p < 0.05). A significant reduction in the laparoscopic approach was observed during 2020 in endometrial cancer (32.1% vs. 14.3% vs. 36.4%, p < 0.05). No significant differences were registered regarding median hospitalization days or intra- and post-operative complications between these periods. Conclusions: The COVID-19 pandemic had a significant impact on the diagnosis and management of most gynecological malignancies, namely, on time to first treatment, chosen oncological therapies and surgical approaches. These results suggest important clinical and healthcare implications that should be addressed in future prospective studies.

Impact of the Coronavirus Disease 2019 pandemic on neoadjuvant chemotherapy use in patients diagnosed with epithelial type ovarian cancer

“…This finding has important clinical implications as it highlights the adoption of SGO’s modified treatment recommendations in ovarian cancer patients during the pandemic, in the US. However, unlike Algera’s and Antunes’ studies ( 2 , 12 ), we reported the adjusted association of the COVID-19 pandemic with neoadjuvant chemotherapy. In the adjusted model, we observed that patients in the older age groups, patients diagnosed at FIGO stages III and IV, and patients with a higher comorbidity burden were more likely to receive neoadjuvant chemotherapy than their respective counterparts.…”

“…Studies conducted in Europe have reported an increase in neoadjuvant chemotherapy use in ovarian cancer patients after the onset of the pandemic ( 2 , 12 ). Our findings are consistent; we observed a 29% increased use of neoadjuvant chemotherapy in patients diagnosed during the pandemic period compared to pre-pandemic patients.…”

“…Studies conducted in Portugal and Netherlands have reported an increased administration of neoadjuvant chemotherapy in patients with advanced ovarian cancer during the COVID-19 pandemic, compared to pre-pandemic periods ( 2 , 12 ). However, to our knowledge, evidence on the impact of the COVID-19 pandemic on neoadjuvant chemotherapy use in the United States (US) has not been reported.…”

Impact of the COVID-19 pandemic on management of surgically treated laryngeal squamous cell carcinoma

“…Furthermore, the evidence regarding the impact of COVID-19 on treatment decisions for other types of cancer remains inconclusive. While some studies report a significant reduction in the use of adjuvant therapy [ 19 ], others indicate an increase in neoadjuvant therapy options [ 20 ]. The levels of evidence in these studies are not yet sufficient and do not yet allow to draw robust conclusions.…”

Optimizing Outcomes through a Multidisciplinary Team Approach in Endometrial Cancer

“…Thus, the importance of discussing individual cases within the context of the MDT was even more crucial [ 36 ]. The pandemic led to delays between MDT discussion and treatment, with the median duration increasing from 23 days in 2019 (pre-pandemic era) to 34 and 36 days in 2020 (during the pandemic with high restrictions) and 2021 (pandemic recovery period) [ 37 ]. Despite these challenges, adhering to guidelines within an MDT framework proved essential.…”