The “collateral damage” of the war on COVID-19: impact of the pandemic on the care of epithelial ovarian cancer

Abstract

The covid-19 pandemic has impacted the management of non-covid-19 illnesses. Epithelial ovarian cancer (EOC) requires long-duration multidisciplinary treatment. Teleconsultation and shared care are suggested solutions to mitigate the consequences of the pandemic. However, these may be challenging to implement among patients who come from the lower economic strata. We report the disastrous impact of the pandemic on the care of EOC by comparing patients who were treated during the pandemic with those treated in the previous year. We collected the following data from newly diagnosed patients with EOC: time from diagnosis to treatment, time for completion of planned chemotherapy, and proportion of patients completing various components of therapy (surgery and chemotherapy). Patients treated between January 2019 and September 2019 (Group 1: Pre-covid) were compared with those treated between January 2020 and December 2020 (Group 2: During covid pandemic). A total of 82 patients were registered [Group 1: 43(51%) Group 2: 39(49)]. The median time from diagnosis to start of treatment was longer in group 2 when compared to group 1 [31(23–58) days versus 17(11–30) days ( p = 0.03)]. The proportion of patients who had surgery in group 2 was lower in comparison to group 1 [33(77%) versus 21(54%) ( p = 0.02)]. Proportion of patients who underwent neoadjuvant (NACT) and surgery were fewer in group 2 in comparison to group 1 [9(33%) versus 18(64%) p = 0.002]. Among patients planned for adjuvant chemotherapy, the median time from diagnosis to treatment was longer in group 2 [28(17–45) days, group 1 versus 49(26–78) days, group 2 ( p = 0.04)]. The treatment of patients with EOC was adversely impacted due to the COVID-19 pandemic. There was a compromise in the proportion of patients completing planned therapy. Even among those who completed the treatment, there were considerable delays when compared with the pre-covid period. The impact of these compromises on the outcomes will be known with longer follow-up.

Treatment delay and treatment pattern modifications among epithelial ovarian cancer patients during the COVID‐19 pandemic: A retrospective cohort study

“…Interpreting the changes in chemotherapy rates is challenging since this data was available as a binary variable. Studies considering the issue of chemotherapy have focused on changes in the neoadjuvant modality 12 , 13 Due to our data's nature, we cannot analyze similar hypotheses. It is possible the changes identified in this cohort are associated with the reduction of stage I patients in the pandemic group.…”

“…A study from India with a cohort of ovarian cancer patients has shown a 14‐day delay in treatment during the pandemic. 12 There are methodological differences that limit comparison. Mainly, the mentioned study actively collected retrospective patient data; our study used systematically institutional registered data.…”

“…In the previously mentioned Indian cohort, the authors hypothesized travel restrictions played a role in treatment delay. 12 It has been shown cancer surgery can be safely performed during the COVID‐19 outbreak, given a COVID‐19‐free path is obtained; whether that requires changing previously established referral paths depends on local epidemiological concerns. 20 Our study found no differences in the distance traveled between both treatment groups.…”

Cancer Patients First Treated with Chemotherapy: Are They More Likely to Receive Surgery in the Pandemic?

“…More specifically, whether newly diagnosed patients receiving upfront chemotherapy went on to get surgery for cancer within a clinically reasonable time window is unknown. A literature search on MEDLINE revealed only 5 studies documenting the subsequent receipt of a cancer surgical resection among new cancer patients initially treated non-surgically during the COVID-19 pandemic ( Appendix A ) [ 7 , 8 , 9 , 10 , 11 ]. Notably, newly diagnosed oesophageal cancer patients in Ireland and breast cancer patients in Turkey did not experience a different rate of surgery following neoadjuvant therapy during the pandemic compared to their pre-pandemic counterparts [ 7 , 10 ].…”

“…Notably, newly diagnosed oesophageal cancer patients in Ireland and breast cancer patients in Turkey did not experience a different rate of surgery following neoadjuvant therapy during the pandemic compared to their pre-pandemic counterparts [ 7 , 10 ]. However, in India, the receipt of surgery after neoadjuvant chemotherapy has dropped among ovarian cancer patients from 64% in 2019 to just 33% during 2020 [ 8 ]. Likewise, The Netherlands reported significantly prolonged wait times from neoadjuvant radiation or chemoradiation initiation to surgery in colorectal cancer patients in 2020 than in 2018/2019 [ 11 ].…”