COVID Has Kept Many Women with Ovarian Cancer From Receiving Care, Survey Finds

"For the first couple of months we essentially shut down, except for cancer care. We even debated stopping some cancer surgeries. Luckily we didn’t have to do that," says Dr. John Nakayama, gynecologic oncologist at University Hospitals Cleveland Medical Center. “One of the big things that we have to worry about is…are these people going to show up more advanced? Are they going to show up sicker? Are they going to have a worse prognosis?"

Cancer patients are particularly affected by COVID-19, both because they need a great deal of medical care, and because chemotherapy and other treatments for this cancer can have immune-suppressing effects that increase the risk for infection.

Dr. Nakayama, together with a few of his colleagues at University Hospitals Cleveland, sought to learn how gynecologic oncologists across the United States were adjusting their practices during the pandemic.

Drops in Cancer Care

The survey first looked at whether the number of people being treated for cancer had significantly decreased. The authors found that it had dropped, by more than 60% for both inpatient (hospital stays) and outpatient care. Most of these cancellations were likely due to efforts by doctors to reduce their patients’ exposure to the virus, given that only 30% of outpatient visits were cancelled by patients themselves.

The gynecologic oncologists surveyed believed that ovarian cancer was the type of cancer most impacted by COVID-19. This may be because doctors rated debulking surgery–one of the main treatments for ovarian cancer–as the most worrisome cancer treatment to give during the pandemic, due to the potential risk of COVID-19 infection. But the doctors also agreed this is one surgery that shouldn’t be delayed.

 

How Has Treatment Changed?

The survey also asked doctors whether they were changing their maintenance treatment plans for women with ovarian cancer. "There’s two commonly used classes of drugs. There’s Avastin, a VEGF inhibitor which works against blood vessels, and the other commonly used class is a PARP inhibitor," says Dr. Nakayama.

While these drugs help prevent the cancer from recurring, PARP inhibitors can weaken the immune system by damaging infection-fighting white blood cells. That could leave women who take these drugs more susceptible to COVID-19 and other infections.

"We asked [the gynecologic oncologists] if they were going to change how they gave those, given COVID-19, and for the most part, people answered that they were not going to change," Dr. Nakayama says. That may be because many women do so well on maintenance therapy that it can actually help them avoid additional medical visits for lab tests and chemotherapy infusions.

COVID-19 is a rapidly evolving situation, and it’s likely to be with us for a while. For as long as the pandemic lasts, doctors will have to balance the need to care for their cancer patients with the need to protect them from the virus. Women who are receiving ovarian cancer treatment during this time should talk to their doctor about any concerns they have, and discuss ways to reduce their risk of COVID, while still getting the therapies necessary to keep their cancer under good control.

 

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