Access to treatment for endometrial cancer patients during the COVID-19 pandemic in Ontario, Canada

ABSTRACT

ObjectivesDuring the first year of the COVID-19 pandemic in Ontario, biopsies for cancer diagnosis decreased by over 40% and surgical cancer treatment decreased by over 25% during the first pandemic wave1. This study aims to assess the impact of the COVID-19 pandemic on endometrial cancer diagnosis and surgical treatment in Ontario, Canada.MethodsCases were identified from January 1, 2017 to December 31, 2022 from endometrial cancer hysterectomy specimens in Ontario Health – Cancer Care Ontario, ePath system. Endometrial biopsy records were matched to surgical specimens by provincial health card number. System performance was compared before (2017–2019) and during (2020–2021) the COVID-19 pandemic.ResultsThere were 10 446 women treated with hysterectomy for endometrial cancer in Ontario from 2017–2021. The majority were low grade (74%) compared to high grade (18%) with 8% unspecified. In April and May 2020 corresponding with the provincial state of emergency, there was a 56% relative reduction in endometrial biopsies. The median time to surgery was 57 days (IQR 41–73) for low grade and 57 days (IQR 42–76) for high grade endometrial cancer. There was no difference in time to surgery and no change in surgical stage at presentation before (2017–2019) or during the pandemic (2020–2021).ConclusionsDespite significant increase in virtual care and decreased operating room time during the COVID-19 pandemic in Ontario, the healthcare system continued to prioritize service delivery to endometrial cancer patients. Importantly, there were no significant surgical delays or upstaging of endometrial cancer, particularly of high-grade histology. 1Walker et al., JAMA Network Open. 2022;5(4)e228855. doi10.1001/jamanetworkopen.2022.8855