In this COVID-19 perspective Ane Gerda Zahl Eriksson describes current considerations regarding options for management of women with gynecologic cancers in the time of the COVID-19 pandemic.
As we face the initial wave of COVID-19, we are aware of the concerns of patients and physicians related to the management of women with gynecologic cancer during the ongoing pandemic. As our healthcare systems are preparing to divert resources to care for patients infected by COVID-19, and social distancing measures are in effect, these last few months have provided valuable insight regarding how we may provide oncologic care within the frames of the pandemic in the inpatient and outpatient settings.
There is still much to learn, as we are making rapid decisions on the basis of limited data to protect patients and healthcare workers alike. Management strategies that may be appropriate for one hospital setting may not be appropriate for another depending on prevalence of COVID-19 and available resources. The opinions expressed here, are current considerations regarding options for management of women with gynecologic cancers, and may change as we learn more about COVID-19. Several societies have created special recommendations or guidelines, some of these resources are listed below.
It is advisable to generate screening questions to rule out coronavirus infection, or perform testing for COVID-19 if available, prior to patients entering the hospital. Restrict visits only to new patients and to those in active treatment for their disease. Don’t allow accompanying family members, or limit to only one person if absolutely necessary. Surveillance visits may be transitioned to telemedicine, or one may postpone visits in asymptomatic patients.
There are reports that patients with ongoing COVID-19 infection have significantly increased postoperative morbidity and mortality. One should therefore postpone any non-emergent surgery until after an infection has resolved. Preoperative testing of asymptomatic women is advised if there is availability of tests. Depending on the institutional intensive care unit (ICU) resources, one must explore options that reduce the risk of admission to ICU after any planed cancer surgery. Appropriate personal protective equipment should be worn by heath care providers in the operating room. For minimally invasive surgery, the use of a closed smoke evacuation/filtration system with Ultra Low Particulate Air Filtration (ULPA) capability is recommended. Surgery with curative intent should not be delayed for any gynecologic cancer.
Women undergoing active treatment should continue their chemotherapy at regular intervals, unless infected. Neoadjuvant chemotherapy in the setting of ovarian cancer may be appropriate for some women to potentially reduce the extent of cytoreductive surgery at time of interval debulking. However, institutional guidelines for patient selection should be adhered to when possible. The risks and benefits of initiating palliative chemotherapy should be considered, and discussed with each patient. Definitive radiotherapy should be initiated for women with gynecologic cancers. Treatment schedules should not be interrupted unless a woman becomes infected.