Keeping Ovarian Cancer Treatment Safe During the Pandemic

When is Surgery Essential?

"We have to be very thoughtful in terms of how we move forward with what is deemed essential surgery. . . and of course, cancer is considered essential surgery," says Dr. McHale. He adds that for patients whose signs and symptoms strongly suggest ovarian cancer, "we continue to pursue moving forward with their planned or scheduled surgery."

But whether the surgery is performed very soon after the diagnosis, or whether it's postponed to allow for several chemotherapy treatments firstcalled neoadjuvant chemotherapyis one of the most important decisions in treatment, and made slightly more complicated by the pandemic.

"I look at is as being very personalized," says Dr. McHale. "And it depends on whether or not we believebased on how a patient presents and based on their pre-existing medical conditionswhether or not they really are an appropriate candidate to go into the operating room immediately to undergo a fairly substantial surgery, or whether they are a better candidate to receive chemotherapy upfront." The goal is for the tumors to respond to the chemotherapy and shrink, making the surgery easier and giving the best chance of a good outcome.

Doctors also have to take into account what the risk of infection is in a particular hospital, whether a patient might require a stay in the intensive care unit, and whether a patient will be able to go directly home from the hospital or might require a transition to a nursing facility. All of these decisions take on more weight when the risk of COVID-19 is added to the deliberation. Often, though, neoadjuvant chemotherapy is the best course of treatment regardless of the pandemic, and more gynecologic oncologists are recommending it to patients as the best option.

Chemotherapy Considerations

Patients who have surgery upfront usually receive six chemotherapy treatmentsonce every three weeksafterwards. But if surgery is considered too risky to do immediately, or if doctors believe shrinking the tumors first is the best course of action, then usually three chemotherapy treatments will be given, followed by an interval debulking surgery, which is then followed by three more chemotherapy treatments  "And hopefully if chemotherapy is done first, the patients respond to the chemotherapy as we would expect, and then they are better suited for proceeding to the operating room," says Dr. McHale.

And now, spurred by COVID-19, doctors are using telemedicine to make chemotherapy treatment even safer. "We were very easily able to pivot to more telemedicine visits," says Dr. McHale. "We can now engage with patients by telemedicinewhether by phone or iPad or laptopso that we can see them and assess them prior to planned chemotherapy." The telemedicine visits also allow patients to ask questions and make their concerns known without having to potentially expose themselves to infection in an office visit.

Of course, chemotherapy can't be delivered by telemedicine, and many chemotherapy infusion centers have now instituted COVID testingfor patients and providersin order to maintain safety for everyone.

Both surgery and chemotherapy for ovarian cancer are essential treatments, and patients don’t have to worry that they won’t be able to receive the right treatment at the right time.  And doctors, hospitals, and chemotherapy infusion centers are all taking steps to make sure that treatment is as safe and successful as possible.

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