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Gynecol Oncol ; 161(2): 414-421, 2021 05.
Article in English | MEDLINE | ID: covidwho-1151485


OBJECTIVE: The current coronavirus pandemic caused a significant decrease in cancer-related encounters resulting in a delay in treatment of cancer patients. The objective of this study was to examine the survival effect of delay in starting concurrent chemo-radiotherapy (CCRT) in women with locally-advanced cervical cancer. METHODS: This is a retrospective observational study querying the National Cancer Database from 2004 to 2016. Women with stage IB2-IVA squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix who received definitive CCRT with known wait-time for CCRT initiation after cancer diagnosis were eligible (N=13,617). Cox proportional hazard regression model with restricted cubic spline transformation was fitted to assess the association between CCRT wait-time and all-cause mortality in multivariable analysis. RESULTS: The median wait-time to start CCRT was 6 (IQR 4-8) weeks. In a multivariable analysis, older age, non-Hispanic black and Hispanic ethnicity, recent year of diagnosis, Medicaid and uninsured status, medical comorbidities, and absence of nodal metastasis were associated with longer CCRT wait-time (P<.05). Women with aggressive tumor factors (poorer differentiation, large tumor size, nodal metastasis, and higher cancer stage) were more likely to have a short CCRT wait-time (P<.05). After controlling for the measured covariates, CCRT wait-time of 6.1-9.8 weeks was not associated with increased risk of all-cause mortality compared to a wait-time of 6 weeks. Similar association was observed when the cohort was stratified by histology, cancer stage, tumor size, or brachytherapy use. CONCLUSION: An implication of this study for the current coronavirus pandemic is that in the absence of aggressive tumor factors, a short period of wait-time to start definitive CCRT may not be associated with increased risk of mortality in women with locally-advanced cervical cancer.

Adenocarcinoma/therapy , COVID-19 , Carcinoma, Adenosquamous/therapy , Carcinoma, Squamous Cell/therapy , Time-to-Treatment , Uterine Cervical Neoplasms/therapy , Adenocarcinoma/secondary , Adult , African Americans/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , COVID-19/epidemiology , Carcinoma, Adenosquamous/secondary , Carcinoma, Squamous Cell/secondary , Chemoradiotherapy , Female , Humans , Lymphatic Metastasis , Medicaid/statistics & numerical data , Medically Uninsured/statistics & numerical data , Middle Aged , Neoplasm Grading , Neoplasm Staging , Proportional Hazards Models , Race Factors , Retrospective Studies , SARS-CoV-2 , Survival Rate , Tumor Burden , United States , Uterine Cervical Neoplasms/pathology
Gynecol Oncol ; 158(1): 37-43, 2020 07.
Article in English | MEDLINE | ID: covidwho-276415


OBJECTIVE: A global pandemic caused by a novel coronavirus (Covid-19) has created unique challenges to providing timely care for cancer patients. In early-stage cervical cancer, postponing hysterectomy for 6-8 weeks is suggested as a possible option in the Covid-19 burdened hospitals. Yet, literature examining the impact of surgery wait-time on survival in early-stage cervical cancer remains scarce. This study examined the association between surgery wait-time of 8 weeks and oncologic outcome in women with early-stage cervical cancer. METHODS: This is a single institution retrospective observational study at a tertiary referral medical center examining women who underwent primary hysterectomy or trachelectomy for clinical stage IA-IIA invasive cervical cancer between 2000 and 2017 (N = 217). Wait-time from the diagnosis of invasive cervical cancer via biopsy to definitive surgery was categorized as: short wait-time (<8 weeks; n = 110) versus long wait-time (≥8 weeks; n = 107). Propensity score inverse probability of treatment weighting was used to balance the measured demographics between the two groups, and disease-free survival (DFS) and overall survival (OS) were assessed. A systematic literature review with meta-analysis was additionally performed. RESULTS: In a weighted model (median follow-up, 4.6 years), women in the long wait-time group had DFS (4.5-year rates, 91.2% versus 90.7%, hazard ratio [HR] 1.11, 95% confidence interval [CI] 0.47-2.59, P = 0.818) and OS (95.0% versus 97.4%, HR 1.47, 95%CI 0.50-4.31, P = 0.487) similar to those in the short wait-time group. Three studies were examined for meta-analysis, and a pooled HR for surgery wait-time of ≥8 weeks on DFS was 0.96 (95%CI 0.59-1.55). CONCLUSION: Our study suggests that wait-time of 8 weeks for hysterectomy may not be associated with short-term disease recurrence in women with early-stage cervical cancer.

Coronavirus Infections/epidemiology , Hysterectomy/statistics & numerical data , Pneumonia, Viral/epidemiology , Time-to-Treatment/statistics & numerical data , Uterine Cervical Neoplasms/surgery , Adult , Aged , Betacoronavirus/isolation & purification , COVID-19 , California/epidemiology , Female , Humans , Hysterectomy/methods , Middle Aged , Pandemics , Propensity Score , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers/statistics & numerical data , Uterine Cervical Neoplasms/mortality