Management of gynecological cancers in the COVID-19 era: a survey from Turkey

Abstract

Objective: This study aimed to investigate how gynecologic oncologists modified their patient management during Coronavirus disease-2019 (COVID-19) in Turkey. Material and Methods: An online survey was sent to gynecologic oncology specialists and fellows in Turkey. It included management questions about strategies for newly diagnosed or recurrent endometrial, cervical, ovarian and vulvar cancer during the pandemic. Participants were asked if treatment of these cancers can be delayed or not and, if yes, the duration of delay. Results: 32.9% of surgeons prescribed oral or intrauterine progesterone for early stage, low-grade endometrial cancer. Conversely, 65.7% and 45.7% of the most surgeons did not change their management for early stage high-grade and advanced stage endometrial cancers respectively, as they perform surgery. 58% and 67.1% of the surgeons continued to prefer standard surgical treatment for microinvasive and early stage cervical cancers, respectively. Radiotherapy was preferred administered with hypofractionated doses for locally advanced cervical cancer (57.1%). While 67.1% of surgeons operated early stage ovarian cancer patients, 50% administered neoadjuvant chemotherapy (NACT) to all advanced stage ovarian cancers and 50% administered more cycles of NACT in preference to interval debulking surgery. 93.7% of the surgeons responded that treatment should not be delayed beyond eight weeks. Conclusion: Most Turkish gynecologic oncologists modified their management of gynecologic cancers due to the COVID-19 pandemic. While chemotherapy was preferred for ovarian cancer, postponement of the surgery, with or without non-surgical options, was considered for early stage, low-grade endometrial cancer. Treatment of gynecologic cancers should be decided on a case by case basis, taking into account local COVID-19 infection rates and availability of health facilities. Prognosis is also an important consideration if delay is contemplated. Standard treatment and normal time-frames should be used if possible. If not, a postponement for a maximum of eight weeks or referral to another center were acceptable alternatives.

Impact of COVID-19 on gynecologic cancer treatment in Japan: a nationwide survey by the Japan Society of Gynecologic Oncology (JSGO)

“…This is the first report examining the clinical overload in high-functioning facilities in Japan, which now have to balance their resources for simultaneous administration of treatment for COVID-19 as well as gynecological malignancy. Similar studies have been reported from other countries and are web-based with anonymous questionnaires, having response rates ranging from 40% to 70% of the intended population [ 5 10 11 ]. The response rate amongst gynecological oncologists in Japan was rather high due to their high sensitivity and willingness to cooperate in data generation.…”

“…There have been some reports from other countries that investigated changes in treatment strategies [ 10 11 ]. These studies have revealed the negative impact of COVID-19 pandemic on the choice of cancer treatment strategies with clinicians choosing radiation or chemotherapy as an alternative to surgery.…”

Psychological Distress Among Cancer Patients During COVID-19 Pandemic in the World: A Systematic Review

“…Although background variables such as age and gender are involved in emergence of psychological distresses during Covid-19 pandemic period, but most of the distresses have occurred due to dysfunctions in oncologic services, changes in routine programs, and delays in treatment protocols (Chen et al, 2020 , 2021a ; Gultekin et al, 2021 ; Nardone et al, 2021 ). Although the modification of treatment protocols in Covid-19 pandemic have been observed in most countries throughout the world, but extensive variation is observed within treatment plans in different regions which is variable from 25- up to 90% according to the literature (Al-Quteimat and Amer, 2020 ; Altin et al, 2020 ; Kuderer et al, 2020 ; Martinelli and Garbi, 2020 ).…”

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

“…In Turkey, an online survey of gynecologic oncology specialists found that 57.1% reported a preference for hypofractionated radiotherapy for locally advanced cervical cancer 19…”