Impact of the COVID-19 pandemic on treatment in patients (pts) with gynecological (GYN) cancer: A comparison with 2019 data from Guy's Cancer Centre

ABSTRACT

Background: The COVID-19 pandemic was declared in the UK in February 2020, impacting significantly on healthcare. Delivery of systemic anti-cancer treatment (SACT) rapidly adapted to minimize patient exposure to SARS-CoV-2. The risks of SACT and concomitant COVID-19 infection are unknown. Here we report the patient/tumour characteristics of pts with any GYN cancer undergoing SACT during the first wave to understand risks of SACT and establish clinical guidelines for safe management in the ongoing SARS-CoV2 pandemic. Methods: Demographic and clinical characteristics of GYN cancer pts receiving at least one SACT between 1st March- 31st May 2020 (first wave COVID-19) were compared to the same three month timeframe in 2019. SARS-CoV2 infection was defined as a positive RT-PCR test for COVID-19. Pts with symptoms or radiological changes alone were not considered SARS-COV2 positive. As part of the Guy's Cancer Cohort we collected information on age, ethnicity, performance status (PS), cancer type, stage (Stg), treatment (SACT, surgery, radiotherapy) and COVID-19 infection. Results: There were no COVID-19 related deaths. 1 pt (0.5%) had SACT delay due to confirmed SARS-CoV-2 infection. Overall mortality at 6 months in each timeframe was 6.9% in 2020 and 8.1% in 2019. In the comparative 3-month intervals, similar numbers of GYN cancer pts received SACT in 2020 compared to 2019 170 patients (126 ovarian;44 non-ovarian) in 2020, 184 (131 ovarian;53 nonovarian) in 2019. Median age was 61y in both groups and BAME ethnicity was balanced. In 2020, more pts had Stg III/IV disease (93%) than 2019 (84%) and fewer had Stg I/II disease (7%) compared to 2019 (16%). PS was 0-1 in 92% of patients in 2020 vs 85% in 2019. The average number of cycles of SACT delivered in each time frame was 3. In 2020 9% received neoadjuvant SACT of which 69% proceeded to planned surgery and 31% were deemed unfit. Comparatively, in 2019 7% received neoadjuvant SACT of whom 75% proceeded to surgery and 25% were deemed unfit. In 2020, 3 pt received chemoradiation compared to 8 in 2019. 40 of 170 pts (24%) had 1-5 week treatment delays in 2020 due to any aetiology with. In 2019 there were treatment delays in 63 of 184 pts (34%). The use of GCSF in support of all SACT regimens was 52% in 2020 vs 11% in 2019. Conclusions: There was no increase in mortality associated with SACT during the first wave of the COVID-19 pandemic in GYN cancer pts. 0.5% of pts had confirmed SARS-COV2 infection. We were able to maintain full SACT delivery for all GYN cancer pts with average cycle number unchanged between 2019 and 2020. There was no significant reduction in surgical debulking rates. In contrast, there was a reduction in GYN cancer pts receiving chemoradiation. More pts presented with Stg III/IV disease in 2020. Increased use of GSCF may have contributed to the reduced chemotherapy delays in 2020. Further research will explore the impact of vaccination.