<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Abstract

The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

The effect of Covid-19 pandemic on gastric cancer surgery

“…It is known that chemotherapy, like surgical interventions, has an immunosuppressive effect [14]. However, chemotherapy cannot be used at all in older adult patients, making surgery the only curative treatment option [15]. Our study established similar waiting times and neoadjuvant therapy rates in both study groups, suggesting that the COVID-19 pandemic has not delayed the surgical treatment of gastric cancer and not increased the tendency to neoadjuvant therapy.…”

Evaluating the feasibility of performing elective gastrointestinal cancer surgery during the COVID‐19 pandemic: An observational study with 60 days follow‐up results of a tertiary referral pandemic hospital

“…Particularly, considering the outcomes of two patients with rectal cancer who may also be evaluated for “watch & wait response”, it is obvious that deferring surgery leads to poor prognosis of these patients. Likewise, the same view can be shared regarding all cancers of GIS 12–14,16,27 . In a recent study by Kucejko et al, 28 it was found that patients with colon cancer who underwent surgery within 3–6 weeks from initial diagnosis had better 5‐year survival than the delayed ones.…”

Gastric cancer during COVID-19 pandemic: What changed?

“…If the treatment ends during the pandemic, it is controversial how to continue the treatment. However, considering the non-negligible risk of immunosuppression, surgery can be recommended to patients with a low risk [18]. In line with these recommendations, an increase was predicted in patients receiving neoadjuvant therapy, but it was observed that the rate of patients who received neoadjuvant therapy during the pandemic period decreased as the disease progressed to an advanced stage and they could not tolerate neoadjuvant therapy.…”