Treating Ovarian Cancer During the COVID-19 Pandemic
- Ovarian cancer patients are continuing to receive appropriate treatment during the COVID-19 pandemic
- Although all hospitals are taking precautions to protect patients, some are postponing surgery to reduce risks
- Beginning treatment with chemotherapy rather than surgery may be a lower-risk alternative that doesn’t compromise outcome
"Cancer care has changed a lot since the COVID pandemic," says Dr. Kris Zanotti, gynecologic oncologist at University Hospitals in Cleveland, Ohio. "The risk to a cancer patient is increased for not only acquiring the disease, but becoming ill from the disease."Read More
The Decision to DeferTypically, treatment for ovarian cancer starts with surgery – staging or sometimes directly to a debulking surgery, where as much of the tumor is removed as possible to leave no visible traces of the cancer behind. The surgery is an extensive procedure involving the removal of the ovaries, uterus, fallopian tubes, and often parts of other affected organs, including the bowel. After debulking, patients receive chemotherapy to eliminate any cancer that remains. This combined treatment has been shown to be fairly effective at eradicating the cancer. But while the surgery can be extremely effective, it does come with risks due to the invasive nature of the procedure and the recovery time needed afterwards. Since the COVID-19 pandemic began, many doctors have had to rethink the wisdom of performing surgery first. A growing number have started patients on chemotherapy first–called neoadjuvant chemotherapy–postponing surgery.
"There's been much debate regarding which patients can be safely deferred and which patients need to undergo their therapies," says Dr. Zanotti. "These debates have been undertaken both locally and at the national level, so that patients who are recommended to defer really are getting deferred based on consensus recommendations."
When determining whether or not to wait on surgery, oncologists take into account how aggressive the cancer is, how effective each treatment might be, and how safe each one is.
Cancer centers across the country have taken immediate actions to reduce their patients’ risk of exposure to coronavirus. "We test ahead of time for COVID and we also keep the cancer centers very COVID-free," says Dr. Zanotti, "if there's a suspected COVID patient, they are moved out of the cancer center."
"If debulking surgery needs to be undertaken," she adds, "precautions are in place, such as COVID testing for the patient before the surgery and limiting exposure in the postoperative setting."
Thanks to these precautions, debulking surgery is considered safe. However, it is still a major intervention that must be handled with care. According to Dr. Zanotti, "If there was any risk of COVID during that time, if the patient either contracted it before surgery and it wasn’t detected, or they contracted it in the recovery phase — the consequences would be fairly severe." This is why, in many cases, oncologists are now recommending that surgery be deferred for many newly diagnosed ovarian cancer patients.
According to Dr. Zanotti, right now neoadjuvant chemotherapy — starting treatment with chemotherapy rather than debulking surgery — is the preferred strategy when possible.
Starting treatment with three cycles of chemotherapy shrinks the tumors, making the surgery done afterwards a less risky and invasive procedure. Usually another three cycles of chemotherapy are administered after the surgery as well. Recent studies indicate that the neoadjuvant chemotherapy strategy for treating newly diagnosed ovarian cancer is just as effective as beginning treatment with surgery, so deferring surgery because of the pandemic doesn’t compromise a patient’s outcome.
Doctors have had to adjust their normal treatment strategies for women with ovarian cancer, balancing the need to control the cancer with the necessity of minimizing COVID exposure. The most important takeaway is that doctors look at each patient individually and determine which strategy — neoadjuvant chemotherapy or surgery — is best for them.