Gynecologic surgical delays, cancellations due to COVID-19 increase adverse outcomes

The COVID-19 pandemic disrupted treatment for gynecologic cancer patients worldwide and caused disease progression and death, according to a prospective cohort study in American Journal of Obstetrics & Gynecology.

“The pandemic has particularly challenged surgical care delivery for those with more advanced or relapsed disease, where surgery can be life-prolonging but not curative,” Christina Fotopoulou, MD, chair in gynecological cancer surgery at Imperial College London, and colleagues wrote. “Surgeries were being delayed or replaced by systemic or palliative care options, which had previously been associated with poorer and less favorable outcomes.”

Fotopoulou and colleagues prospectively evaluated 3,973 patients with gynecologic cancer who either underwent surgery (n = 3,784) for curative or life-prolonging purpose or had their planned surgery canceled (n = 189) in early 2020 during the COVID-19 pandemic. They studied patients at 227 centers in 52 countries.

Recruitment for the study started from the day each center had its first COVID-19-related admission and continued for 3 months. Each participant had follow-up at 3 months after their care decision was made.

The primary outcome was the incidence of pandemic-related changes in care for patients with gynecologic cancer. Thirty-day perioperative mortality and morbidity, unresectable disease or disease progression, emergency surgery and death were secondary outcomes.

Results showed that one in five (20.7%) patients scheduled to undergo gynecologic cancer surgery had to change their care plans because of the pandemic. Significant delays longer than 8 weeks occurred for 11.2% of patients, with about half of them being patients with ovarian cancer.

Delays lasting for more than 8 weeks were linked to disease progression and death when compared with those who underwent surgery in fewer than 8 weeks (22.4% vs. 17.9%; P = .024).

Of the 189 patients who had their operations canceled, 1 in 5 (18%) had disease progression, and five (2.7%) died within 3 months of the decision for surgery. A greater proportion of patients who did vs. did not have operations canceled were from low- and middle-income countries, had stage 3 or 4 cancers, lived in locations that underwent a full lockdown and had low COVID-19 burden.

Of the 3,778 surgical patients with recorded cancer sites, 22 tested positive for COVID-19 perioperatively. Because of this, these patients had longer hospital stays after surgery and higher predefined surgical morbidity and mortality rates compared with those who did not test positive for the virus.

“This study identified a significant proportion of patients [who] had their surgical plans delayed or canceled, which was associated with poorer outcomes,” Fotopoulou and colleagues wrote. “The results represent an early and clear signal that robust mechanisms and pathways are urgently needed to ensure adequate cancer care even in times of crisis without detrimental oncologic compromise.”