Introduction
Following the identification of the novel coronavirus and its ensuing
COVID-19 disease in late 2019, it quickly became a global pandemic. As
different countries faced different challenges, new guidance was rapidly
published on how to treat and control the spread of the disease. Whilst
it is clear that some disparities do exist within the literature, it is
evident that there are many similarities in how departments responded to
this pandemic and this has been true within the field of gynaecological
oncology. Whilst it is still too early for the publishing of large
trials, this article aims to summarise the current available global
guidance for the management of gynaecological oncology patients
throughout this crisis.
Oncology patients are at risk of greater mortality as a consequence of
contracting coronavirus, however do not appear to be at a higher risk of
contracting the illness, with no evidence of increased incidence within
this population. The increased risk of mortality is due to the
immunosuppressive state of malignancy as well as current or previous
administration of chemotherapeutic agents (1). A study from China has
shown that the mortality of COVID-19 with a current cancer is 7.6%,
compared to 1.4% if no comorbidities present but was less than having
comorbidities such as cardiovascular disease (13.2%), diabetes (9.2%),
hypertension (8.4%) and chronic respiratory disease (8%)(2).
Although delaying surgery due to concerns about patients contracting
COVID-19 peri-operatively, reduced intensive care facilities, reduced
staff, reduced theatre availability and reducing risk to staff members
and current patients, this needs to be offset with the risk of a rapidly
progressing cancer where delay could lead to severe complications and
disease progression to the point of affecting surgical cure and
therefore ultimately patient prognosis.
There are several identified themes that remain common and consistent
between different countries and are applicable to gynaecological
oncology as a whole.
- Reduce transmission
- Managing limited resources including staffing
- Treatment prioritisation and continuation of cancer surgery
- Exploration of alternative therapy