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Chapman GC, Smrz SA, Gordon JC, Lynam SK, Strohl AE, Ferguson LA, Armstrong AJ, Zanotti KM. Gynecologic cancer care in the first year of the COVID-19 pandemic. Gynecol Oncol 2023; 178:138-144. [PMID: 37862793 DOI: 10.1016/j.ygyno.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To analyze the impact of the early COVID-19 pandemic on the diagnosis and initiation of treatment for patients with gynecologic cancer. METHODS Patients diagnosed with gynecologic cancer in the National Cancer Database during 2017-2020 were included. For the first aim, incidence rate ratios were calculated to compare gynecologic cancer diagnosis in the first year of the COVID-19 pandemic to the three years prior, and factors associated with a reduction in diagnosis were identified. For the second aim, patients who experienced an 8-week delay in cancer treatment were compared to those who did not. Multivariate logistic regression was used to identify factors associated with treatment delay. Propensity score analysis was utilized to compare the rate of cancer treatment delay in patients who were diagnosed with COVID-19 to those who were not. RESULTS The incidence rate ratio of being diagnosed with gynecologic cancer in 2020 versus 2017-2019 was 0.90 (95%CI 0.90-0.91). Factors associated with increased risk of missed or delayed diagnosis in 2020 included cervical cancer, earlier cancer stage, younger age, lower levels of medical comorbidity, and lack of health insurance. In 2020, factors associated with treatment delay included COVID-19 diagnosis (aOR 1.50, 95%CI 1.35-1.67), in addition to race and ethnicity, insurance type, comorbidity, cancer stage, and primary site. The risk of treatment delay remained significantly elevated in patients diagnosed with COVID-19 after propensity-score matching. CONCLUSIONS Gynecologic cancer diagnosis and timely provision of care were negatively impacted during the first year of the COVID-19 pandemic, with certain subgroups at elevated risk.
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Affiliation(s)
- Graham C Chapman
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA.
| | - Stacy A Smrz
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Jennifer C Gordon
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Sarah K Lynam
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Anna E Strohl
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Lindsay A Ferguson
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Amy J Armstrong
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
| | - Kristine M Zanotti
- University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology. 11000 Euclid Ave, Cleveland, OH 44106, USA
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Brower JV, Rhodes SS, Remick JS, Russo AL, Dunn EF, Ayala-Peacock DN, Petereit DG, Bradley KA, Taunk NK. Effect of COVID-19 on Gynecologic Oncology Care: A Survey of Practicing Gynecologic Radiation Oncologists in the United States. Adv Radiat Oncol 2023; 8:101188. [PMID: 36974086 PMCID: PMC9968481 DOI: 10.1016/j.adro.2023.101188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose The COVID-19 pandemic has placed demands and limitations on the delivery of health care. We sought to assess the effect of COVID-19 on the delivery of gynecologic oncologic care from the perspective of practicing radiation oncologists in the United States. Methods and Materials An anonymous online survey was created and distributed to preidentified radiation oncologists in the United States with clinical expertise in the management of gynecologic patients. The survey consisted of demographic questions followed by directed questions to assess specific patterns of care related to the COVID-19 pandemic. Results A total of 47 of 96 invited radiation oncologists responded to the survey for a response rate of 49%. Fifty-six percent of respondents reported an increase in locally advanced cervical cancer with no similar increase for endometrial, vulvar, or vaginal patients. Most respondents (66%) reported a pause in surgical management, with a duration of 1 to 3 months being most common (61%). There was a reported increased use of shorter brachytherapy regimens during the pandemic. Most providers (61%) reported caring for at least 1 patient with a positive COVID-19 test. A pause or delay in treatment due to COVID-19 positivity was reported by 45% of respondents, with 55% reporting that patients chose to delay their own care because of COVID-19-related concerns. Total treatment times >8 weeks for patients with cervical cancer were observed by 33% of respondents, but occurred in >25% of patients. Conclusions Data from this prospectively collected anonymous survey of practice patterns among radiation oncologists reveal that the COVID-19 pandemic resulted in delays initiating care, truncated brachytherapy treatment courses, and a reported increase in locally advanced cervical cancer cases at presentation. These data can be used as a means of self-assessment to ensure appropriate decision making for gynecologic patients during the endemic phase of COVID-19.
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Affiliation(s)
- Jeffrey V. Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Radiation Oncology Associates–New England, Manchester, New Hampshire
| | - Sylvia S. Rhodes
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jill S. Remick
- Department of Radiation Oncology, Winship Cancer Institute, Emory School of Medicine, Atlanta, Georgia
| | - Andrea L. Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily F. Dunn
- Department of Radiation Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, Oregon
| | | | - Daniel G. Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, South Dakota
| | - Kristin A. Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Neil K. Taunk
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Kozica‐Olenski SL, Ghelani DP, Boyle JA, Vincent AJ. The impact of
COVID
‐19 on a specialised menopause clinic: Changes in practice and women's experiences. Aust N Z J Obstet Gynaecol 2023. [DOI: 10.1111/ajo.13670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/26/2023] [Indexed: 03/29/2023]
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Komatsu H, Nakagawa S, Yamagami W, Yamada H, Miyashita S, Yoshino K, Kawana K, Shibahara H, Hamatani T, Aoki D. Impact of the COVID-19 pandemic on surgery for benign diseases in gynecology: A nationwide survey by the Japan Society of Obstetrics and Gynecology. J Obstet Gynaecol Res 2023; 49:314-320. [PMID: 36288970 PMCID: PMC9875113 DOI: 10.1111/jog.15467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023]
Abstract
AIM This study aimed to clarify the impact of coronavirus disease 2019 on gynecology practice in Japan, in particular, on surgeries for benign gynecological diseases. METHODS An online questionnaire was distributed to 966 facilities in Japan, including core facilities, facilities participating in perinatal and gynecologic oncology registries, and facilities certified for training by the Japanese Society of Obstetrics and Gynecology Endoscopy. The number of surgeries performed was compared between 2019 and 2020, when the novel coronavirus disease was prevalent. RESULTS Five hundred and eighty (58.2%) facilities responded. The total number of surgeries decreased from 129 648 in 2019 to 118 565 in 2020, by 8.5%, for all surgical procedures. However, there was a clear increase in the number of robotic surgeries performed in 2020 compared to that in 2019 for all populations. The number of total hysterectomies decreased markedly from 15 385 in 2019 to 12 531 in 2020, a fall of 10.1%. CONCLUSIONS The number of surgeries for benign gynecological diseases decreased by 8.5% in 2020 compared to that in 2019. This value is among the lowest in the world.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and GynecologyTottori UniversityTottoriJapan
| | - Satoshi Nakagawa
- Department of Gynecology and ObstetricsOsaka University School of MedicineOsakaJapan
| | - Wataru Yamagami
- Department of Gynecology and ObstetricsKeio University School of MedicineTokyoJapan
| | - Hideto Yamada
- Center for Recurrent Pregnancy LossTeine Keijinkai HospitalSapporoJapan
| | | | - Kiyoshi Yoshino
- Department of Obstetrics and GynecologyUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Kei Kawana
- Department of Obstetrics and GynecologyNihon University School of MedicineTokyoJapan
| | - Hiroaki Shibahara
- Department of Obstetrics and GynecologySchool of Medicine Hyogo Medical University NishinomiyaJapan
| | - Toshio Hamatani
- Department of Gynecology and ObstetricsKeio University School of MedicineTokyoJapan
| | - Daisuke Aoki
- Department of Gynecology and ObstetricsKeio University School of MedicineTokyoJapan
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How COVID-19 Pandemics Changed the Treatment Protocols for Patients with Gynecological Tumors. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
It was found that oncological patients are4 to 8 times more likely of developing severe forms of COVID-19 infection than other patients, so mortality is higher in patients with gyneco-logical cancer. Due to this pandemic, reported delays in diagnosis and treatment of genital cancer and changes in disease management, may influence the natural history of neoplasm. This fact adds more stress and fear for patients with neoplasms. Adequate protective measures are essen-tial for SARS CoV2 infection avoidance and lead to changes in healthcare professionals clinical practice. Prioritization is important, but direct personal interactions should be limited. However, gynecological tumors surgery, chemotherapy, and radiotherapy should continue as high priority practices, without essential modification. The conclusion is that COVID-19 pandemic has affect-ed many guides for management of diseases, especially oncological. Adaptations in clinical prac-tice may avoid viral infection and reduce mortality and severe complications.
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