ABSTRACT
BACKGROUND AND AIM: The COVID-19 pandemic has changed the health landscape for the entire population but for future mothers facing the outbreak of the coronavirus pandemic (COVID-19) it has induced, uncertainty, social isolation, and fear for their unborn child, and has contributed to aggravated stress and anxiety. The purpose of a digital follow-up protocol is to study which specific aspects of the pandemic (e.g., viral exposure, psychological vulnerability) may lead to adverse mother and offspring outcomes and aims to understand how maternal physical and mental health is associated with symptoms observed in their offspring, and how these symptoms evolve over time. METHOD(S): The protocol uses a prospective cohort design to study the biological risks associated with pre- and post-partum SARS-CoV-2 exposure of mothers and the neurodevelopmental risk of their offspring. Given the multifaceted nature of Covid-19 exposure which seem to accumulate over time, network analyses will be conducted on data from three maternal (within the first 12 months after birth) and three child assessments (at 1,3 and 6 yrs. of age) collected using online digital questionnaires and surveys which includes (maternal) depression, anxiety, health and trauma symptoms, exposure to SARS-CoV-2, and psychosocial risk while their offspring will be assessed for cognitive and behavioral consequences. RESULT(S): Ultimately, we anticipate that an easily accessible digital follow-up facilitates early detection of neurocognitive and behavioral problems, based on recognition of maternal and child risk. CONCLUSION(S): The resulting risk stratification of child cognitive and behavioral difficulty over time may lead to the development of timely and personalized intervention programs.
ABSTRACT
Background: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Material(s) and Method(s): This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Result(s): Charts of 5,164 EC patients were retrieved. Overall, 2,718 and 2,446 women with EC received treatment in period 1 and 2, respectively. The prevalence of patients aged > 65 years was similar between the 2 study periods (1,400 [51.5%] in period 1 vs. 1,248 [51.0%];p=0.726). Considering data on the histological characterization, the prevalence of endometrioid FIGO grade 1, 2, and 3 was consistent over the study period (p=0.855). However, the prevalence of non-endometrioid EC was lower in period 1 than in period 2 (15.6% vs. 17.9%;p=0.032). Surgery was the mainstay of treatment before and during the COVID-19 pandemic. Overall, 2,539 and 2,286 women received surgery in period 1 and 2, respectively (93.4% vs. 93.5%;p=0.948). Primary conservative attempts (i.e., progesterone-based therapy) was performed in 72 (2.7%) and 56 (2.3%) patients in period 1 and 2, respectively (p=0.406). The adoption of minimally invasive surgery was consistent in the two study periods (p=0.976). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). The adoption of vaginal brachytherapy as adjuvant treatment remained stable in the study periods (11.9% vs. 11.1%;p=0.325). Adjuvant therapies indication has increased during the COVID-19 pandemic (p<0.001). In particular, the use of adjuvant radiotherapy (26.8% vs. 30.7%;p=0.001) and chemotherapy (25.1% vs. 30.1%;p<0.001) alone or in combination increased from period 1 to 2. Conclusion(s): Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic.
ABSTRACT
Background: COVID-19 outbreak has correlated with the disruption of screening activities, regular follow up visits, and diagnostic assessments. The risk of misdiagnosis and delayed diagnosis has consequently increased during the pandemic. Endometrial cancer is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms (e.g. abnormal vaginal bleeding). Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of endometrial cancer patients. Material and methods: This is a retrospective study involving 53 centers in Italy. We evaluated patterns of presentation and treatment of endometrial cancer patients before (i.e. period 1: from 03/01/2019 to 02/29/2020) and during (i.e. period 2: from 01/04/2020 to 3/31/2021) the COVID-19 outbreak. Results: Medical records of 5,117 endometrial cancer patients have been retrieved: 2,688 and 2,429 women treated in period 1 and period 2, respectively. The prevalence of endometrioid International Federation of Obstetrics and Gynecologists (FIGO) grade 1, 2, and 3 was consistent over the study period (p=0.769). However, the prevalence of non-endometrioid endometrial cancer was lower in period 1 than in period 2 (15.7% vs. 17.9%;p=0.015). The characteristics and pattern of different surgical approaches were consistent in the two study periods (p=0.664). Before COVID-19 pandemic, 1,838 (73.2%), 647 (25.7%), and 25 (0.9%) patients had minimally invasive, open and vaginal surgery, respectively. During the COVID-19 pandemic, 1,661 (73.2%), 567 (24.9%), and 41 (1.8%) patients had minimally invasive, open, and vaginal surgery, respectively. Nodal assessment was omitted in 684 (27.3%) and 478 (21%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.8% in period 1 vs. 53.1% in period 2;p<0.001). Adjuvant therapy was omitted in 1,269 (50.5%) and 1,019 (44.9%) patients receiving treatment in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during the COVID-19 pandemic (p<0.001). Conclusions: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of endometrial cancer patients. These findings highlight the need to implement healthcare services during the pandemic.