Lucia Nappi1,2, Margaret Ottaviano3,4,5, Pasquale Rescigno6,7, Marianna Tortora4,5, Giuseppe L Banna8, Giulia Baciarello9, Umberto Basso10, Christina Canil11, Alessia Cavo12, Maria Cossu Rocca13, Piotr Czaykowski14, Ugo De Giorgi15, Xavier Garcia Del Muro16, Marilena Di Napoli17, Giuseppe Fornarini18, Jourik A Gietema19, Daniel Y C Heng20, Sebastien J Hotte21, Christian Kollmannsberger1, Marco Maruzzo10, Carlo Messina22, Franco Morelli23, Sasja Mulder24, Craig Nichols25,26, Franco Nolè13, Christoph Oing27, Teodoro Sava28, Simona Secondino29, Giuseppe Simone30, Denis Soulieres31, Bruno Vincenzi32, Paolo A Zucali33, Sabino De Placido4,5, Giovannella Palmieri4,5. 1. British Columbia Cancer, Vancouver Cancer Center, Vancouver, BC, Canada. 2. Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada. 3. Ospedale del Mare, Naples, Italy. 4. Department of Clinical Medicine and Surgery, University of Naples "Federico II,", Naples, Italy. 5. Centro di riferimento Campania per i tumori rar (CRCTR) Regional Rare Tumors Reference Center, Naples, Italy. 6. The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom. 7. The Institute of Cancer Research, London, United Kingdom. 8. Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom. 9. Oncology Medicine Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France. 10. Oncology Unit, Oncology Department, Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy. 11. The Ottawa Hospital Cancer Center, University of Ottawa, Ottawa, Canada. 12. Villa Scassi Hospital, Genoa, Italy. 13. European Institute of Oncology (IEO), IRCCS, Milan, Italy. 14. Cancer Care Manitoba, University of Manitoba, Winnipeg, Canada. 15. Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy. 16. Catalan Institute of Oncology, Barcelona, Spain. 17. National Institute of Tumors "G. Pascale", Naples, Italy. 18. IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 19. University Medical Center Groningen, Groningen, The Netherlands. 20. Tom Baker Cancer Center, University of Calgary, Calgary, Canada. 21. Juravinski Cancer Center, McMaster University, Hamilton, Canada. 22. Santa Chiara Hospital, Trento, Italy. 23. IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 24. Radboud University Medical Center, Nijmegen, The Netherlands. 25. Testicular Cancer Commons, Portland, Oregon, USA. 26. Southwest Oncology Group (SWOG) Group Chair's Office, Portland, Oregon, USA. 27. University Medical Center Eppendorf, Hamburg, Germany. 28. Oncologia Azienda Unità Locale Socio Sanitaria 6 (AUSLSS6) EUGANEA, Padua, Italy. 29. Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 30. IRCCS "Regina Elena" National Cancer Institute, Rome, Italy. 31. Center Hospitalier de l'Université de Montréal, Montreal, Canada. 32. University Campus Bio-Medico, Rome, Italy. 33. Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy.
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS: To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS: Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS: To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS: Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity.
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