A propensity score-matched retrospective cohort study of hysterectomies for benign disease during the COVID-19 pandemic.

OBJECTIVE: This study aimed to evaluate how the pandemic might have affected the number of elective and urgent hysterectomies for benign gynecological pathologies in a single-care tertiary center in the State of São Paulo, Brazil, and to identify if there were any changes in the need for blood transfusions. METHODS: This is a single-center retrospective cohort study. It involved all non-puerperal and non-oncological hysterectomies from October 2018 to July 2021. Patients were divided into two groups, namely, the pandemic group (46 patients) and the control group (92 patients). Data were collected by reviewing the physical and electronic patient records. We carried out the statistical analysis using the RStudio software. RESULTS: The number of planned hysterectomies was 82 in the pre-pandemic group and 23 in the analysis group, representing a 71.9% decrease. When considering only urgent surgeries, 10 of them happened in the pre-pandemic group, while 23 occurred in the pandemic group, representing an increase of 130%. CONCLUSION: Elective hysterectomies may improve the quality of life of women, reducing abnormal bleeding and pelvic pain. Treatment delay can worsen patients' physiological and biological conditions, such as lower labor production, humor, and social aspects, increasing costs to the healthcare system.

Ovarian cancer hospitalization rates during the COVID-19 pandemic in the state of Sao Paulo and correlation with pandemic-related variables

Introduction/BackgroundThe COVID-19 pandemic which began in 2020 disrupted healthcare services and changed patient behavior. Our objective was to identify changes in hospitalization rates of ovarian cancer patients from 2016 to 2020, comparing pre-pandemic and pandemic levels. We also aimed to assess, if these changes happened and whether they were correlated with pandemic-related variables.MethodologyAggregated data were obtained from the State of Sao Paulo Secretary of Health regarding ovarian cancer hospitalization, average social distancing rates, COVID-19 incidence, mortality, lethality, and both COVID-specific infirmary and ICU bed occupation rates. Hospitalizations for ovarian cancer were categorized as either clinical or surgical treatments. These data were available at the state level and for each state’s subdivisions. We performed a Joinpoint analysis in order to verify if there were changes regarding hospitalization rates during the study period. We also calculated hospitalization rate ratios and verified if they were correlated with pandemic-related variables.ResultsOverall hospitalization rates in the state fell coinciding with the start of the pandemic. At the state level, clinical hospitalization rates did not show changes in their trend during the study period, while surgical hospitalization rates started to decrease two trimesters before the pandemic began and remained decreasing. Surgical hospitalization rate ratios were inversely correlated with COVID-specific ICU bed occupation rates during the third trimester of 2020, with a Pearson Correlation coefficient of -0.50 (95% CI: -0.78 to -0.05, p = 0.03). An increasing number of exclusively public-insured persons were identified in the state, with a Pearson Correlation coefficient of 0.95 (95% CI: 0.88–0,98, p < 0.001).ConclusionSurgical hospitalization rate ratios fell during the third trimester of 2020 and were inversely correlated with ICU occupation. This demonstrates the impact of the COVID-19 pandemic on the treatment of conditions that compete for the same healthcare resources.

Treatment delay and treatment pattern modifications among epithelial ovarian cancer patients during the COVID-19 pandemic: A retrospective cohort study.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare access and medical treatment, including oncological care. Treatment delay in ovarian cancer could impact survival. We aimed to assess if there were delays and treatment changes in a cohort of epithelial ovarian cancer patients. METHODS: A retrospective cohort of epithelial ovarian cancer patients included cases diagnosed during the first 22 months of the COVID-19 pandemic in the state of Sao Paulo and those diagnosed in the 22 months preceding the outbreak. Time-to-treat was measured in days. In each group, surgery and chemotherapy proportions were assessed according to healthcare insurance status. RESULTS: A 56.2% reduction in epithelial ovarian cancer diagnosis was identified during the pandemic group compared to the prepandemic group; fewer patients were diagnosed in stage I (p < 0.01). Time-to-treat increased from 18.9 to 23 days (p < 0.01). Surgery in the public sector fell from 74.6% to 65.3% during the pandemic, compared to 87.1% to 68.8% in the private sector. CONCLUSION: There were fewer overall diagnoses, reduced stage I diagnosis, increased time-to-treat, and a reduction in the proportion of patients submitted to surgery. Brazil's public healthcare system demonstrated a higher resiliency to treatment change than the private sector.

Impact of coronavirus disease 2019 pandemic on breast cancer screening and detection of high-risk mammographic findings.

OBJECTIVE: The coronavirus disease 2019 pandemic has disrupted cancer screening worldwide. This study aims to analyze the changes in the rates of screening mammograms and BIRADS 4 or 5 mammograms during the coronavirus disease 2019 pandemic in the opportunistic scenario. METHODS: We integrated three different public databases from the state of São Paulo, Brazil, to obtain the rate of screening mammograms per 1,000, and the rate of BIRADS 4 or 5 mammograms per 100,000 women aged from 50 to 69 years in the years from January 2017 to December 2020. RESULTS: The mean monthly screening mammograms decreased from 14.8/1,000 in 2019 to 9.25/1,000 in 2020, with the lowest rates being recorded in May 2020 (3.1/1,000). The mean monthly high-risk mammograms decreased from 12.8/100,000 in 2019 to 9.1/100,000 in 2020, with the lowest rates being recorded in April 2020 (4.3/100,000). CONCLUSIONS: Coronavirus disease 2019 pandemic significantly decreased mammography screening in an opportunistic scenario, a warning sign for decreasing diagnosis of breast cancer in early stages, and increasing advanced stage diagnosis and mortality in the future.

Impact of ICU bed availability on ovarian cancer surgical hospitalization rates during the first wave of the coronavirus disease 2019 pandemic.

OBJECTIVES: The coronavirus disease 2019 pandemic, which began in 2020, disrupted healthcare services. Reports of changes in surgical activities coincide with the outbreak period. We aimed to identify if changes could be determined in hospitalization rates of ovarian cancer patients from 2016 to 2020, comparing pre-pandemic and pandemic levels. METHODS: Aggregated data were obtained from the State of São Paulo Secretary of Health regarding ovarian cancer clinical and surgical hospitalization, both Coronavirus disease-specific ICU and infirmary bed occupation rates, average social distancing rates, coronavirus disease 2019 incidence, mortality, and lethality rates. We performed the joinpoint analysis to verify if there were changes regarding hospitalization rates during this period. We also calculated hospitalization rate ratios and tested if they were correlated with pandemic-related variables. RESULTS: Hospitalization rates in the state fell, coinciding with the pandemic. Surgical hospitalization rate ratios were inversely correlated with Coronavirus disease-specific ICU bed occupation rates during the third trimester of 2020, with a Pearson's correlation coefficient of -0.50 (95%CI -0.78 to -0.05, p=0.03). CONCLUSION: These results demonstrate the impact of the coronavirus disease 2019 pandemic on the treatment of conditions that compete for the same healthcare resources.