Decision-Making During the Pandemic
- Treatment options may depend on how many cases of COVID-19 there are in an area
- Sometimes surgery is postponed and chemotherapy prescribed first
- New oral anti-cancer drugs that can be taken at home are an alternative to chemotherapy that must be administered intravenously in a special center
- Telemedicine visits can replace some in-person medical visits
Patients across the country are still getting appropriate treatments for their cancer, but there are challenges. "You need to look at each patient individually and make the decision that's best for them long term so that they're comfortable with their care and we're being as aggressive as we can to treat the cancer," says Dr. Lynn Parker, a gynecologic oncologist at the Norton Cancer Institute in Louisville, Kentucky.
Read MoreFor ovarian cancer patients with advanced-stage disease, postponing treatment for months is not an option. But that treatment doesn't necessarily have to be surgery. The challenge is deciding which patients need to report to the operating room right away, and which can be treated with chemotherapy firstcalled neoadjuvant chemotherapy.
The surgical dilemma is even greater when doctors aren't exactly sure what they're dealing with. Not every pelvic mass is malignant, and patients with benign growths may be able to safely wait for surgery. But patients with confirmed ovarian cancer don't have that kind of flexibility. As one gynecologic surgeon told Survivornet, "We want to make sure that we’re not putting off the actual ovarian cancer patients a lot more than necessary, but we’re also not taking every single mass that probably is benign to the operating room. It's a tricky discussion."
Patients with a diagnosis of ovarian cancer whose surgery is postponed, though, are certainly not being left untreated. There are a number of effective chemotherapy options.
Chemotherapy First, Now, or Later?
Most chemotherapy is administered in special infusion centers. These centers are considered less of a COVID-19 risk than hospitals, though the centers still require patients to come in contact with staff and other patients. The centers are now taking special precautions which may include testing patientsand stafffor fever, keeping waiting room seating as distant as possible, asking patients to come in without family members, and having patients wait in the car until they're called that the staff is ready to treat them.
Patients undergoing chemotherapy also need to have regular bloodwork done to monitor how the chemotherapy is affecting their red blood cell, white blood cell, and platelet count. Some doctors are dealing with this additional risk by having patients report to labs nearer to their homes rather than coming in to the hospital for the test.
But even with all these precautions intravenous chemotherapy may still considered risky for some patients, in some areas, during the pandemic. 'Fortunately there are still more treatment options.
New Oral Medications
Medications that can be taken in pill form at home are generally safer for cancer patients than drugs given by IV, which are administered in a medical setting and increase a patient's risk of exposure to the virus. Several new drugs recently approved to treat ovarian cancer fall into this category.
PARP inhibitors are an oral class of anti-cancer drugs that work by targeting cancer's genetic material, preventing the cells from repairing themselves so they die off rather than spread. PARP inhibitors can be prescribed electronically and delivered directly to patients at home. The three PARP inhibitors approved to treat ovarian cancer are niraparib (brand name Zejula), olaparib (brand name Lynparza), and rucaparib (brand name Rubraca).
"We're still prescribing PARP inhibitors, even in the current COVID-10 pandemic, because they have significant benefits for patients either for treatment of recurrent cancer or as a maintenance therapy after initial chemotherapy for patients with advanced disease," says Dr. Parker.
Telemedicine Visits
Another way cancer care has changed during the pandemic is that many hospitals and medical offices are now scheduling telemedicine rather than in-person visits whenever possible. Patients who are in remission and are just being watched can be followed up with teleconferencing, which allows doctors to get a sense of patients' general well-being, to interact, and discuss how they're doing. Patients can discuss any symptoms or concerns, tell the doctor their experience with side effects, and ask any questions they have during these virtual visits.
This approach eliminates the risk of infection, though doctors caution that it's not the same as a visit to an office where your temperature can be measured and doctors can check for any physical changes or investigate any pain or side effects of therapy you're experiencing.
Each individual case is different, and patients should discuss with their oncologists which treatments are essential now, and which can be safely postponed until the pandemic has waned. The important thing is to remember that there are many options for ovarian cancer treatment, even in the middle of a pandemic. Surgery is still being performed, and chemotherapy is still being administered. Patients and their doctors can decide together what kind of treatment approach is best given their specific medical issues and the reality of the pandemic.
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