Gynaecologic cancer care during COVID-19 pandemic in India: a social media survey.

ABSTRACT

BACKGROUND: Health care services across the globe are undergoing a major transformation to combat the coronavirus disease 2019 (COVID-19) pandemic. Regardless of the strength of health care infrastructure across different economies, all countries are diverting their resources toward care for COVID-19 patients. AIM: The aim of this survey was to evaluate the pattern of care of gynaecologic cancers in a developing country during the COVID-19 pandemic. METHODS: An anonymous survey consisting of 20 questions intended for the gynaecologic cancer care providers with emphasis on their current practice and approach to their patients was distributed online via social media from April 30 to May 31, 2020. Basic descriptive statistics were applied. RESULTS: Among a total of 61 respondents, 63.9% were gynaecologic oncologists, 18.0% were radiation oncologists and 18.0% were medical oncologists. Majority, that is, 95.1% health care professionals felt that COVID-19 pandemic has had a significant change on their practice pattern and 56.2% practitioners had stopped registering new cases of cancer. In 75.4% centers surgery was being done for gynaecologic cancer cases and among them 60.8% were doing surgery only for cases requiring immediate intervention. Among the centers providing chemotherapy, 39.1% had switched to oral drugs. Among the centers providing radiation, 40.9% were providing radiation to cases based on their type and urgency and 9.0% had implemented hypofractionation. In early stage low risk cases, majority, that is, 34.0% centers were managing as before. In early stage high-risk cases, 32.6% centers were managing as before. In advanced stage endometrial cancer cases, 28.8% had postponed any treatment and 28.8% administered chemotherapy. In early stage, epithelial ovarian cancer 65.9% centers were performing complete staging of the disease. In advanced stage epithelial ovarian cancer, 65.9% centers preferred biopsy followed by neoadjuvant chemotherapy and 11.3% centers performed primary debulking surgery. In cases of interval debulking surgery, 73.3% centers deferred surgery till all six cycles of chemotherapy was completed. In cases of recurrent ovarian cancer amenable for secondary debulking surgery, 38.6% preferred chemotherapy. In early stage cervical cancer, surgical treatment was provided in 46.5% centers. In locally advanced cervical cancer, chemoradiation was given in 65.9% centers. In cases of metastatic cervical cancer, 46.6% centers were performing palliative radiation. CONCLUSION: COVID-19 has affected the treatment of gynecologic cancers patients and health care professionals are trying to mitigate the damage by incorporating new elements which are suited to the current scenario.