Management of patients with ovarian cancer in the COVID‐19 era

Abstract

At the beginning of 2020, coronavirus disease 2019 (COVID‐19) spreads worldwide. Patients with ovarian cancer should be considered at high‐risk of developing severe morbidity related to COVID‐19. Most of them are diagnosed in advanced stages of disease, and they are fragile. Here, we evaluated the major impact of COVID‐19 on patients with ovarian cancer, discussing the effect of the outbreak on medical and surgical treatment.

Considerations for the Care of Women with Gynecological Cancers during the COVID-19 Pandemic

“…Many centers have Ind J Car Dis Wom:2020;5:256-259 incorporated a CT scan of the chest and a nasopharyngeal swab in the presurgical evaluation protocols. 4 It is also prudent to avoid or postpone all nonurgent surgical procedures till the pandemic wanes. Hanna et al have proposed a conceptual framework which offers guidance on prioritization of care of cancer patients during the pandemic.…”

“…Lymphadenectomy may be avoided due to its uncertain benefit. It can be considered in cases where nodal status would be helpful to make decisions 4 In patients with advanced stage disease, tissue biopsy should be done to confirm the diagnosis, and neoadjuvant chemotherapy and delayed surgery is a reasonable approach, given the risks of extensive surgical procedures during the pandemic. In patients already on neoadjuvant chemotherapy, extending the plan to six cycles, rather than three, before interval cytoreductive surgery can be considered, depending on resource availability, feasibility of surgery and institutional management protocols; recognizing additional chemotherapy can deplete the bone marrow reserve and cause immunosuppression.…”

“…In patients already on neoadjuvant chemotherapy, extending the plan to six cycles, rather than three, before interval cytoreductive surgery can be considered, depending on resource availability, feasibility of surgery and institutional management protocols; recognizing additional chemotherapy can deplete the bone marrow reserve and cause immunosuppression. 8, 9,4 Maintenance therapy may be withheld after completion of platinum-based adjuvant chemotherapy, since repeat visits may place additional risk of infection on the patient, families, and healthcare teams. 9 Patients with ovarian cancer should, as far as possible, be treated in COVID-19 free specialized healthcare facilities.…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…It can be considered in cases where the nodal status would help make decisions regarding adjuvant chemotherapy for ovarian cancers are best avoided during the COVID-19 pandemic. 114 A tissue biopsy should be performed for confirmation in patients with clinically advanced-stage disease. In such cases, three to six cycles of neoadjuvant chemotherapy and delayed surgery are the recommended approaches since extensive surgical procedures can be risky for patients and health care workers during the pandemic.…”

“…This decision should be balanced against the additional risk of chemotherapy induced immunosuppression. 111,112,114 Maintenance therapies following completion of adjuvant chemotherapy may be withheld, considering the additional risk of infection on the patient, families, and health care teams due to the need for repeated visits. 112 In patients, active COVID-19 infection, surgery, and chemotherapy should be postponed till recovery.…”