1. Reduce transmission
The main way this is achieved is through the reduction of direct contact between people. This includes through staff members and patients alike and as such, current practice required to be changed to improve the safety for everyone within the healthcare environment.
Where possible, meetings have been advised to be reduced to a minimum and performed over the internet to prevent direct contact. Within oncology, multidisciplinary team meetings are integral to the determination of oncology patients’ care and as such are required to continue throughout this pandemic. Where possible, this should occur over teleconferencing or video link to reduce the risk of transmission (3,4).
Outpatient activity should be reduced to limit the risk of cross-infection, particularly of high-risk patients, and alternatives such as telephone consultations or patient-initiated follow-up should be considered. Fast track referrals can be triaged and where possible postponed until the risk of COVID transmission is deemed acceptable. If postponement it not acceptable, patients should be seen in a facility where diagnostic tests, such as hysteroscopy or biopsy, can be performed during that visit to reduce attendances(5).
Women who have a confirmed diagnosis of COVID-19 should not attend for outpatient appointments(5) and should have their surgical treatment postponed for at least 15 days (3). Only once they are asymptomatic and have completed this time of isolation should their case be reviewed.
For the women whose surgery is indicated to proceed, where possible, they should be operated on in a negative-pressure theatre and this should be a dedicated theatre, free from cross-contamination. Post-operatively, patients should be transferred to dedicated wards, free from coronavirus and the route of transfer should be carefully considered to reduce cross-infection whilst transferring patients around the hospital(5).
Follow-up should be minimised and should be conducted over the telephone or online unless a recurrence is strongly suspected and additional tests should be postponed until after the pandemic except where symptoms require these to be performed or for disease monitoring (6). Additionally, post-operative follow-up for women with cervical and vulval tumours who require clinical examination which cannot be performed over telephone and as such should be seen but can be delayed by 2 months(3).