Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers

Abstract

Background. The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). Materials and Methods. To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. Results. Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from

Management of Breast Cancer Patients During the Coronavirus Disease 2019 Pandemic: The Experience From the Epicenter of China, Wuhan

“…It is suggested by many oncologists that a designed postponing of elective surgery, cytotoxicity chemotherapy, or immune checkpoint inhibitors for some stable cancer could be considered in high-risk areas 24 , 25 , 26 . A survey of 343 oncologists from 28 countries also indicated that most participants would use less aggressive therapy to avoid potential risk during the pandemic 27 . For patients receiving periodic chemotherapy in our department, we appropriately changed the diagnosis and treatment strategies according to the actual condition.…”

In Reply

“…Our recommendation of "withholding the chemotherapy until an active COVID-19 infection has resolved or has been ruled out with highly accurate molecular testing" comes from a consensus opinion of 53 specialists in reference centers for the treatment of germ cell tumors and derives by the high mortality of COVID-19 in symptomatic cancer patients [2].…”

Medical Liability in Cancer Care During COVID-19 Pandemic: Heroes or Guilty?

“…Immediate treatment should be promptly considered for those tumors at high risk of early mortality and highly sensible to chemotherapy (i.e., acute leukemia, aggressive lymphomas, metastatic germ cell tumors) where the cancer-related prognosis is poorer than COVID-19-related mortality. In the midst of the pandemic, an international survey among experts belonging to three cooperative groups (Italian germ cell tumors, European G3 domain, genitourinary medical oncologists of Canada) posed the question whether the delay of treatment would be acceptable for a highly curable cancer as germ cell tumors (GCT) (12). Although there was a large consensus among experts in treatment discontinuation or delay for COVID-19-positive patients, management strategies of COVID-19-free GCT patients remained intact reflecting the priority to guarantee a high standard of care for GCT patients, as shown by the low rate of elective surgical delay as well as the management of poor-risk patients (12).…”

“…In the midst of the pandemic, an international survey among experts belonging to three cooperative groups (Italian germ cell tumors, European G3 domain, genitourinary medical oncologists of Canada) posed the question whether the delay of treatment would be acceptable for a highly curable cancer as germ cell tumors (GCT) (12). Although there was a large consensus among experts in treatment discontinuation or delay for COVID-19-positive patients, management strategies of COVID-19-free GCT patients remained intact reflecting the priority to guarantee a high standard of care for GCT patients, as shown by the low rate of elective surgical delay as well as the management of poor-risk patients (12). Moreover, an immediate local treatment should be always offered in patients with localized disease where surgery or radiotherapy may play a curative role (13,14).…”