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EP197/#293 Table 1ConclusionsClinicopathologic presentation of EC recurrence did not change in our population after COVID. This suggests that health care adaptations utilized during the pandemic, including telemedicine, warrant further investigation.
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OBJECTIVES: Patients with gynecologic malignancies may have varied responses to COVID-19 infection. We aimed to describe clinical courses, treatment changes, and short-term clinical outcomes for gynecologic oncology patients with concurrent COVID-19 in the United States. METHODS: The Society of Gynecologic Oncology COVID-19 and Gynecologic Cancer Registry was created to capture clinical courses of gynecologic oncology patients with COVID-19. Logistic regression models were employed to evaluate factors for an association with hospitalization and death, respectively, within 30 days of COVID-19 diagnosis. RESULTS: Data were available for 348 patients across 7 institutions. At COVID-19 diagnosis, 125 patients (36%) had active malignancy. Delay (n = 88) or discontinuation (n = 10) of treatment due to COVID-19 infection occurred in 28% with those on chemotherapy (53/88) or recently receiving surgery (32/88) most frequently delayed. In addition to age, performance status, diabetes, and specific COVID symptoms, both non-White race (adjusted odds ratio (aOR) = 3.93, 95% CI 2.06-7.50) and active malignancy (aOR = 2.34, 95% CI 1.30-4.20) were associated with an increased odds of hospitalization. Eight percent of hospitalized patients (8/101) died of COVID-19 complications and 5% (17/348) of the entire cohort died within 30 days after diagnosis. CONCLUSIONS: Gynecologic oncology patients diagnosed with COVID-19 are at risk for hospitalization, delay of anti-cancer treatments, and death. One in 20 gynecologic oncology patients with COVID-19 died within 30 days after diagnosis. Racial disparities exist in patient hospitalizations for COVID-19, a surrogate of disease severity. Additional studies are needed to determine long-term outcomes and the impact of race.
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Many gynecologic oncology practices suffered a significant drop in volume at the onset of the recent COVID-19 pandemic and have yet to recover to pre-pandemic volumes. The decrease in volume has not only important implications for cancer diagnosis, surveillance, and management, but also for revenue generation by gynecologic oncology practices. We sought to explore how the implementation of telehealth could aid in maintaining revenue in a time of limited in-person encounters. We created a model to calculate the outpatient clinic production of a theoretical gynecologic oncology practice with a volume of 600 patients per month in revenue value units (RVUs) and US dollars. We modeled 3 scenarios including a baseline case with all in-person visits, a 30% drop in volume with all in-person visits, and a 30% telehealth/70% in-person visit scenario at baseline volume. We determined the loss of revenue and number of in-person visits avoided in each scenario. Additionally, we modeled how revenue may change if the incorporation of additional telehealth visits allowed for an increased number of in-person new patient visits. A practice with a monthly volume of 600 in-person patient visits would generate 1050 RVUs/$66,150 per month. If this theoretical practice suffered a 30% decrease in volume to 420 in person visits per month, production would drop to 736 RVUs/$46,368 per month. This decrease in $19,844 of monthly revenue would avoid 180 in-person encounters. If baseline practice volume was maintained by transitioning to 30% telehealth/70% in-person visits, revenue only drops by $7,372 per month, while avoiding 180 in-person encounters. If clinic structure utilizes independent advance practitioners for in-person encounters, clinic density can increase if physicians concurrently perform televisits. This increased clinic density and the downstream revenue generating effect of more new patient visits results in higher practice revenue. If transitioning 2 follow-up patients to telehealth allowed for one additional in-person new patient per clinic, production would increase by 308 RVUs/$19,404 per month. If transitioning 4 patients to telehealth allowed 2 additional new patient visits, production would increase by 656 RVUs/$41,476 per month. Though the optimal telehealth strategy for oncology is still unknown, implementing telehealth during a time of limited in-person visits may help ameliorate the financial loss to a practice. Additionally, if utilization of advanced practitioners and telehealth allows for more new patient evaluations and increased clinic density, a practice may stand to increase revenue substantially. A thorough understanding of the tradeoffs associated with telehealth are essential for establishing an optimal strategy for delivering, safe high-quality cancer care during this unprecedented global pandemic. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)