Special Considerations during the Pandemic
Chemotherapy
- Make sure patients are tested for COVID-19 prior to beginning chemotherapy treatment and periodically during the weeks or months of treatment
- Make sure all providers who come in contact with patients are tested frequently
Surgery
- Consider whether a patient will need to be admitted to the intensive care unit after surgery
- Consider whether a patient will be able to return directly home after surgery or will need to transition to a nursing facility first
The COVID-19 pandemic has changed life for people all over the world in many ways. And treatment for ovarian cancer is no exception. Cancer specialists have been working overtime to learn more about the coronavirus and how it affects people with cancer. They've also been carefully tailoring treatment plans to both reduce the risk of infection and still deliver the best cancer care possible.
Precautions for Patients during Chemotherapy
Read More After a diagnosis of ovarian cancer, one of the first major decisions that has to be made is whether to begin treatment with surgery, or to start with chemotherapy to shrink the tumors firstcalled neoadjuvant chemotherapyif surgery might be more successful afterwards. "Independent of COVID-19, that's the first question we ask ourselves: Is primary surgery appropriate, or do we do chemotherapy first?” says
Dr. Ramez Eskander, gynecologic oncologist at the University of California, San Diego. Because of the pandemic, some doctors are opting to postpone surgery and begin treatment with chemotherapy. But the practice varies from place to place, partly determined by the local risk of COVID-19 "In our practice, we really didn't increase the frequency of neoadjuvant chemotherapy over what our baseline utilization is," says Dr. Eskander. "Irrespective of the COVID-19 pandemic, there are many patients where chemotherapy, as an initial treatment is the most appropriate route to take, followed by what we call an interval surgical resection." That said, administering chemotherapy infusions during the pandemic does require some extra precautions. "Right now, every patient who gets treated with chemotherapy is receiving COVID testing prior to the start of systemic chemotherapy, and while they're on treatment," says Dr. Eskander. All the medical providers who come in contact with patients are also regularly tested.
Extra Considerations with Surgery
Dr. Eskander says that physicians also need to think about issues surrounding surgery and how these factors might be affected by the pandemic. For instance, what are the chances that a patient will need to be admitted to the intensive care unit after surgery, and would that be considered more risky during the pandemic? Or what if a patientbecause of living alone, other health issues or frailtymight not be able to go directly home after hospitalization, and will need interim care in a nursing facility? Is that an extra risk worth taking? "We really need to be very thoughtful about the implications of these subsequent steps," says Dr. Eskander.
During the pandemic, as always, doctors must make treatment decisions on a case-by-case basis. But whatever the decisionsurgery first or neoadjuvant chemotherapya changing medical landscape brought on by COVID-19 are now part of treatment considerations.
Dr. Eskander says the pandemic is an opportunity for medicine to grow and develop its ability to tailor treatment for ovarian cancer in the context of COVID-19. "To make sure," he says, "that our patients are taken care of."
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Ramez Eskander, MD, is a board-certified gynecologic oncologist at UCSD. Read More
