Evaluation of patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer

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Background: The fallopian tubes play an important role in the pathogenesis of epithelial ovarian cancer. This has led to recommendations for performing bilateral salpingectomy as primary prevention of ovarian cancer, the opportunistic salpingectomy (OS). OS has gained territory globally, however with unwanted practice variation. Since all women have the right to be informed on OS, a patient decision aid (PtDA) on OS and salpingectomy as sterilization method has been developed to provide uniform counseling and reduce this practice variation. The aim of this study was to evaluate the effect of the PtDA on the decision-making process. Methods: As part of the STOPOVCA-implementation-study we conducted a multicenter observational prospective study between July 2020 until now. Women who were eligible for OS were invited to use the PtDA while they considered whether or not to undergo OS during gynecological surgery. Evaluation was performed using digital questionnaires regarding their decision, the decision process, and the PtDA. Preliminary. Results: In total 84 women participated to the questionnaire of which 71 used the PtDA. The majority chose to undergo OS (90%). Main reasons for women choosing OS were the risk reducing effect of ovarian cancer and the unnecessary preservation of the fallopian tubes after childbearing. After using the PtDA, from patients perspective the extent to which they were involved in the decision-making process was high, and the decisional conflict low. Patients thought it is a usable aid and recommend other women who face the decision regarding OS to use it with an 8.4 out of 10. Conclusions: The PtDA supports the decision-making on whether or not to undergo OS among patients who have completed childbearing and undergo abdominal gynecological surgery.

Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the 'Dutch Gynecological Oncology Audit'

OBJECTIVE

The COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare.

METHODS

This population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018-2020. Four periods were identified based on COVID-19 hospital admission rates: 'Pre-COVID-19', 'First wave', 'Interim period', and 'Second wave'. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018-2019.

RESULTS

A total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018-2019 (mean 2018-2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018-2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed.

CONCLUSIONS

The COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.