As the number of COVID-19 cases continues to rise globally, many countries are still enforcing strict lockdown measures to aid in the containment of the virus. During this period of uncertainty, many individuals and businesses are eager to resume a sense of normalcy.
The pandemic has had a tremendous impact on the healthcare landscape, meaning patients are having to adapt to new methods of care. Dr. Randall Gibb, a Gynecologic Oncologist from Billings, Montana, claims that the coronavirus has negatively impacted most individuals on some scale; however, those diagnosed with ovarian cancer may have additional concerns. He takes the time to explain how COVID-19 may affect their treatment plan and offers some helpful coping strategies.
COVID-19 (CoronaVirus Disease 2019) is caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) virus explains Dr.Randy. It is part of a larger group of viruses that are known to cause diseases in mammals and birds. This particular strain of virus was first reported in December of 2019 in the Wuhan region of China, and brought to the attention of the World Health Organization (WHO) on December 31st, 2019. Patients infected with the virus may or may not show symptoms, however the most common include fever, cough, and shortness of breath. Patients may also experience runny nose, sore throat, body aches and pains, and chest pain. All patients, especially immunocompromised patients such as those with ovarian cancer, have been advised by the CDC (Centers for Disease Control and Prevention) to practice proper hand hygiene, avoid large gatherings, and avoid touching your face. It is also recommended to stay at home as much as possible to reduce the risk of becoming infected by an asymptomatic carrier.
While there continues to be much uncertainty surrounding the virus, it is known that patients with pre-existing conditions, especially those that have oncologic diseases and are immunocompromised, are at a higher risk of becoming infected than the general population. These patients also tend to have more interactions with healthcare systems, which further increases the likelihood of exposure.
Dr. Gibb explains that many hospitals and clinics have cancelled all scheduled in-person appointments, and are only seeing patients on an emergency basis. However, healthcare continues to be provided, with most physicians conducting telemedicine appointments, either over video call or over the phone. Many are offering offsite appointments for those requiring in-person visits, as well as routine chemotherapy administration.
Centralization of cancer care has been seen more frequently throughout the pandemic, as many hospitals convert to COVID-19 units only, other centers have focused on providing care for cancer patients only.
General Cancer Strategies
Looking at a study from China, there are three primary strategies that the healthcare system should be working on to decrease the threat of COVID-19 for all cancer patients, says Dr. Gibb. For patients where it has been decided that the risk of COVID-19 outweighs the risk of their cancer, treatment should be delayed, including elective surgery and chemotherapy. This risk can be decided based on the COVID-19 positive cases in their community vs. the stability of their patients’ cancer. Secondly, if patients are required to come in for appointments, appropriate personal protective equipment should be worn by both healthcare providers and patients, helping to prevent the spread of infection, while also ensuring proper sanitization of offices and equipment. Lastly, for cancer patients that are infected with SARS-CoV-2, they should be monitored more closely, as they can decompensate quickly.
Ovarian Cancer Strategies
While most ovarian cancer surgeries are considered essential rather than elective, decisions are being made on a case-by-case basis depending on the urgency and COVID-19 situation in the geographical area. Dr.Randy claims that in and around Billings, MT, the cases seem to have peaked early on, with only 2-3 new cases being reported daily. Keeping an eye on the situation, Dr. Randall Gibb and his colleagues have been making decisions on which patients would benefit from having radical surgical resection now rather than waiting until the pandemic has subsided. These patients require close observation post op, and some may require mechanical ventilation, adding to the equation of whether or not they should wait for treatment.
Other centers have employed the use of neoadjuvant chemotherapy in the interim in an attempt to hold off on the need for surgery until the need for hospital beds is fully assessed. While this method does help decrease the risk of postsurgical death, it is not the standard of care, and only prolongs the use of chemotherapeutic drugs until surgery is done.
As healthcare teams around the world adapt to the new norms set forth due to COVID-19, they continually work hard to provide healthcare in a safe and effective manner. Measures from patient safety to disease management have been put in place in accordance with the CDC, government, and other healthcare organizations. If patients are concerned or have questions, they should reach out to their healthcare teams who can properly guide and assist them on what they are doing and what can be done in the following weeks-months regarding their health and treatment plans.