The Society of Gynecologic Oncology (SGO) has published guidelines for care during the COVID-19 pandemic crisis, recommending that clinicians engage patients in shared decision making about anticancer treatment, including considering potential risks associated with increased risk of COVID-19 infection and complications.1
“The COVID-19 pandemic has rapidly and drastically changed our approach to the care of gynecologic cancer patients,” the authors wrote.
The guideline was developed with consideration of several studies that suggest that patients with cancer may be more susceptible to COVID-19 infection, and the many infections were acquired at the hospital. In addition, patients with cancer who were admitted with COVID-19 were shown to be at a higher risk of severe events compared with patients without cancer.
“Careful deliberation is required in the decision making surrounding anticancer therapy and clinical trials management during this challenging time to optimize patient outcomes via balancing the benefit of therapy with the risk of COVID-19 infection and its attendant adverse sequelae,” the authors wrote.
The SGO recommends prioritizing first-line treatment with curative intent and palliative therapy for patients with uncontrolled cancer symptoms at risk of hospitalization. For maintenance treatment, the incremental survival benefit should be considered and weighed against the risks of COVID-19.
Other recommendations aim to lower the risk of infection such as temperature screening of patients, limiting the frequency of infusions and in-person visits. Oral therapies, rather than infusion-based treatments, should be considered when possible, and patients should be screened for COVID-19 before beginning any anticancer treatments.
For patients who require first-line treatment, neoadjuvant therapy is recommended to delay or avoid primary surgical debulking. When appropriate, the SGO recommends that regimen selection should favor those with fewer infusion visits, including the use of oral medications, selecting a regimen with fewer separate infusion visits, and selecting dosing that spreads out infusions. Radiation therapy should be avoided unless it is used with curative intent.
The SGO highlighted that immunotherapy-related pneumonitis has a similar presentation as COVID-19 infection, and recommends that if pneumonitis is suspected, the patient should undergo COVID-19 testing before steroids are initiated.
The guideline acknowledges that there are geographic differences in terms of COVID-19 burden, available local resources, and institutional and local government mandates, thus emphasizing that an individualized approach to cancer care delivery should be used.
Pothuri B, Secord AA, Armstrong D, et al. Anti-cancer therapy and clinical trial considerations for gynecologic oncology patients during the COVID-19 pandemic crisis [published online 2020]. Gynecol Oncol. doi: 10.1016/j.ygyno.2020.04.694