Possible Treatment Changes during the Pandemic
- Surgery may be delayed to avoid possible exposure to the COVID-19 virus
- Neoadjuvant chemotherapy–chemotherapy before surgery–may be preferred to manage the above risk
- Data shows that treatment sequence – chemotherapy vs surgery first – does not have an impact on outcomes though neoadjuvant chemotherapy can be preferred to help shrink tumor and make surgery easier when possible.
- Clinical trials may not be enrolling as many new patients
"Fortunately, as we're now recovering and opening from the pandemic, things have mostly gone back to normal," says Dr. Elisabeth Diver, gynecologic oncologist at Stanford University. But there are still areas in the country where this might not be true, and gynecologic oncologists have had to think about altering the way they treat ovarian cancer in order to protect their patients.
Read MoreWomen with ovarian cancer are usually given six cycles of chemotherapy in addition to surgery. All six of the treatments may be given after recovery from the operation. Or, depending on a woman's cancer and her general health, she may receive three chemotherapy treatments before surgery, and three afterwards. Chemotherapy before surgery is called neoadjuvant chemotherapy.
"Women should feel good about either one," says Dr. Diver. "Typically a gynecologic oncologist will make the decision having to do with the details of each patient." Some of these decisions may be influenced by the COVID pandemic. In areas where pandemic cases are not yet under control, doctors may decide to delay surgery and give adjuvant chemotherapy so that patients can avoid the hospital until the risk of COVID-19 is lessened. But many women are advised to have neoadjuvant chemotherapy as the best choice for them regardless. "And thanks to multiple large randomized trials, we know that we have choices for how we sequence those two treatments that have equal clinical outcomes," says Dr. Diver.
Other Changes
Medical offices have taken many other steps to make sure that patients stay safe during COVID:
- When you next see your gynecologic oncologist, for example, you may wait in a car or somewhere else other than the office waiting room until the doctor is ready to see you.
- The waiting room will have fewer seats than usual, or seats roped or taped off.
- Someone on staff will take your temperature before you are taken back for your exam or treatment.
- You will probably have to wear a mask.
- You may be asked to use hand sanitizer.
In fact, your next office visit may not be an office visit at all. Many doctors are urging patients who don't need physical exams to schedule telemedicine appointments, where you will meet with the doctor over a video call and have an opportunity to ask questions about your diagnosis and treatment. For patients undergoing chemotherapy, these telemedicine visits, are an opportunity to go over lab results, get help for side effects, and express any concerns.
The COVID-19 pandemic has changed medical care in many ways. While additional precautions are now needed to reduce transmission between people, doctors want patients to know that one thing that hasn't changed is the quality of care that cancer patients receive.
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