Duygu Altın1, İbrahim Yalçın2, Ghanim Khatib3, Mine Dağgez Keleşoğlu4, Sedat Akgöl5, Ayşe Büşra Önder6, İlker Kahramanoğlu7, Tevfik Güvenal8, Samet Topuz9, Fuat Demirkıran7. 1. Clinic of Obstetrics and Gynecology, Ordu University Training and Research Hospital, Ordu, Turkey 2. Clinic of Obstetrics and Gynecology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey 3. Department of Obstetrics and Gynecology, Çukurova University Faculty of Medicine, Adana, Turkey 4. Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey 5. Clinic of Obstetrics and Gynecology, University of Health Sciences Turkey, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey 6. Clinic of Obstetrics and Gynecology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey 7. Department of Obstetrics and Gynecology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey 8. Department of Obstetrics and Gynecology, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey 9. Department of Obstetrics and Gynecology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
Abstract
Objective: This study aimed to investigate how gynecologic oncologists modified their patient management during Coronavirus disease-2019 (COVID-19) in Turkey. Material and Methods: An online survey was sent to gynecologic oncology specialists and fellows in Turkey. It included management questions about strategies for newly diagnosed or recurrent endometrial, cervical, ovarian and vulvar cancer during the pandemic. Participants were asked if treatment of these cancers can be delayed or not and, if yes, the duration of delay. Results: 32.9% of surgeons prescribed oral or intrauterine progesterone for early stage, low-grade endometrial cancer. Conversely, 65.7% and 45.7% of the most surgeons did not change their management for early stage high-grade and advanced stage endometrial cancers respectively, as they perform surgery. 58% and 67.1% of the surgeons continued to prefer standard surgical treatment for microinvasive and early stage cervical cancers, respectively. Radiotherapy was preferred administered with hypofractionated doses for locally advanced cervical cancer (57.1%). While 67.1% of surgeons operated early stage ovarian cancer patients, 50% administered neoadjuvant chemotherapy (NACT) to all advanced stage ovarian cancers and 50% administered more cycles of NACT in preference to interval debulking surgery. 93.7% of the surgeons responded that treatment should not be delayed beyond eight weeks. Conclusion: Most Turkish gynecologic oncologists modified their management of gynecologic cancers due to the COVID-19 pandemic. While chemotherapy was preferred for ovarian cancer, postponement of the surgery, with or without non-surgical options, was considered for early stage, low-grade endometrial cancer. Treatment of gynecologic cancers should be decided on a case by case basis, taking into account local COVID-19 infection rates and availability of health facilities. Prognosis is also an important consideration if delay is contemplated. Standard treatment and normal time-frames should be used if possible. If not, a postponement for a maximum of eight weeks or referral to another center were acceptable alternatives.
Objective: This study aimed to investigate how gynecologic oncologists modified their patient management during Coronavirus disease-2019 (COVID-19) in Turkey. Material and Methods: An online survey was sent to gynecologic oncology specialists and fellows in Turkey. It included management questions about strategies for newly diagnosed or recurrent endometrial, cervical, ovarian and vulvar cancer during the pandemic. Participants were asked if treatment of these cancers can be delayed or not and, if yes, the duration of delay. Results: 32.9% of surgeons prescribed oral or intrauterine progesterone for early stage, low-grade endometrial cancer. Conversely, 65.7% and 45.7% of the most surgeons did not change their management for early stage high-grade and advanced stage endometrial cancers respectively, as they perform surgery. 58% and 67.1% of the surgeons continued to prefer standard surgical treatment for microinvasive and early stage cervical cancers, respectively. Radiotherapy was preferred administered with hypofractionated doses for locally advanced cervical cancer (57.1%). While 67.1% of surgeons operated early stage ovarian cancerpatients, 50% administered neoadjuvant chemotherapy (NACT) to all advanced stage ovarian cancers and 50% administered more cycles of NACT in preference to interval debulking surgery. 93.7% of the surgeons responded that treatment should not be delayed beyond eight weeks. Conclusion: Most Turkish gynecologic oncologists modified their management of gynecologic cancers due to the COVID-19 pandemic. While chemotherapy was preferred for ovarian cancer, postponement of the surgery, with or without non-surgical options, was considered for early stage, low-grade endometrial cancer. Treatment of gynecologic cancers should be decided on a case by case basis, taking into account local COVID-19infection rates and availability of health facilities. Prognosis is also an important consideration if delay is contemplated. Standard treatment and normal time-frames should be used if possible. If not, a postponement for a maximum of eight weeks or referral to another center were acceptable alternatives.
Authors: Vinicius Cesar Moterani; Nino Jose Wilson Moterani; Francisco Jose Candido Dos Reis Journal: J Surg Oncol Date: 2022-08-05 Impact factor: 2.885