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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 2 | Page : 338-339 |
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Impact of COVID-19 on gynecological cancer patients
Sushmita Rath, Pallavi Parab
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| Date of Submission | 08-May-2020 |
| Date of Decision | 08-May-2020 |
| Date of Acceptance | 09-May-2020 |
| Date of Web Publication | 19-Jun-2020 |
Correspondence Address:
Sushmita Rath
Department of Medical Oncology, Tata Memorial Centre, Dr. E. Borges Marg, Parel, Mumbai ? 400 012, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/CRST.CRST_181_20
How to cite this article:
Rath S, Parab P. Impact of COVID-19 on gynecological cancer patients. Cancer Res Stat Treat 2020;3:338-9 |
As the coronavirus disease 2019 (COVID-19) pandemic progresses and reaches its peak, a multidisciplinary approach is required to minimize the morbidity, mortality, and complications of anticancer treatment in patients with COVID-19 who have gynecological malignancies.[1],[2] As we know, patients who undergo extensive surgery or intensive chemotherapy are more predisposed to complications from COVID-19.[3],[4]
Restriction of outpatient visits, reducing the number of inpatient admissions, attending to follow-up patients [5] and providing them teleconsultation, has been the current strategy at the Tata Memorial Center (Mumbai, India), as a part of cancer management during the current COVID-19 crisis.[6]
Therefore, with regard to gynecological malignancies, we would like to propose the following chemotherapy plan, which is currently employed in the gynecological department of medical oncology at the Tata Memorial Center and also adequately highlighted in both the articles in the previous issue of CRST.[1],[2]
- For patients with cervical cancer
- Those who need definite treatment with chemoradiation, either in the primary or adjuvant setting, can receive radical radiation alone rather than with concurrent chemotherapy to reduce the chances of neutropenia and thrombocytopenia
- For patients with advanced cervical cancers, radical radiation should be given, wherever possible; if chemotherapy is required for patients with a high disease burden and a good performance status, it is better to give single-agent carboplatin.
- For patients with ovarian cancer
- Neoadjuvant and adjuvant chemotherapy are an important part of the management of advanced-stage epithelial carcinoma of the ovary. Single-agent carboplatin can be started in the first cycle, and the patient can be reassessed for suitability for starting a doublet in the second cycle [7]
- In patients with recurrent epithelial ovarian cancers: for patients with platinum-sensitive disease, re-challenge with single-agent carboplatin can be considered according to the platinum-free interval, whereas in patients with platinum-resistant disease, it is best to consider oral metronomic chemotherapy with tamoxifen, etoposide, and cyclophosphamide. Patients with a poor performance status can be offered symptomatic and palliative care.
- As rightly pointed out in the articles,[1],[2] in view of the high cure rates, the management of ovarian germ cell tumors and gestational trophoblastic neoplasms can be continued with adequate chemotherapy as indicated. For patients with extensive lung metastasis, in older patients, and in those with compromised glomerular filtration rate, bleomycin can be avoided in the chemotherapy regimen.
- For patients with endometrial cancers
In the adjuvant setting, starting adjuvant radiation should be considered whenever possible.[8] For hormone receptor-positive cancers and endometrioid histopathology, letrozole or megestrol acetate can be started. In hormone receptor-positive metastatic or recurrent endometrial cancers, hormone therapy should be started, and platinum-based chemotherapy can be started in patients with a high disease burden.
In conclusion, during this COVID-19 pandemic, treatment decisions need to be individualized to minimize the risk of infection, and if possible, elective anticancer treatment should be delayed or deferred.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Dessai S, Nachankar A, Kataria P, Abyankar A. Management of patients with gynecological cancers during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:40-8.  |
| 2. | Goel A. Management of cancer during the COVID pandemic: Treatment of gynecological malignancies. Cancer Res Stat Treat 2020;3 Suppl S1:106-9. |
| 3. | Ramirez PT, Chiva L, Eriksson AG, Frumovitz M, Fagotti A, Martin AG, et al. COVID-19 global pandemic: Options for management of gynecologic cancers. Int J Gynecol Cancer 2020;30:561-3. |
| 4. | Bansal N, Ghafur A. COVID-19 in oncology settings. Cancer Res Stat Treat 2020;3 Suppl S1:13-4. |
| 5. | Srivastava P, Tilak TV, Patel A, Das CK, Biswas B, Mahindru S, et al. Advisory for cancer patients during the COVID pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:145-8. |
| 6. | Pramesh CS, Badwe RA. Cancer management in India during Covid-19. N Engl J Med 2020;382:e61. |
| 7. | International Collaborative Ovarian Neoplasm Group. Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: The ICON3 randomised trial. Lancet 2002;360:505-15. |
| 8. | Munshi A, Rastogi K. Management of cancer during the COVID-19 pandemic: Practical suggestions for the radiation oncology departments. Cancer Res Stat Treat 2020;3 Suppl S1:115-8. |
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