Change in practice of RRSO consults and procedures during the COVID-19 pandemic (563)

Abstract

Objectives: To investigate the impact of the Covid-19 pandemic on risk-reducing salpingo-oophorectomies (RRSO).Methods: An electronic survey was sent out to 1,127 full members of the Society of Gynecologic Oncology in August 2021. Survey data included physician characteristics, practice location, and self-reported subjective and objective data about their RRSOs and consults.Results: We received 69 responses from US gynecologic oncologists. Two-thirds of respondents were female; the mean age of respondents was 46 years (range: 35-65). Most respondents performed 10-20 RRSOs per year (median: 15, range: 2-75). During the pandemic, 76% of providers delayed RRSOs, and currently, 11% are delaying these surgeries. From March 2020, to February 2021, most providers (86%) transitioned some RRSO consults to telehealth. There was no correlation between uptake of telemedicine by age (R2=0.09) or gender (p=0.80). Those in the West Coast region reported significantly more use of telemedicine than in the Southwest (p<0.01) and Southeast (p<0.01). Providers using telemedicine spent more time with patients in-person than compared to virtually (37 min vs 33 min, p=.005). Sexual function was discussed almost 100% of the time during inperson (median: 100%, range: 10-100) and telehealth (median: 100%, range: 10-100) visits. We found female providers reduced their time discussing sexual function from in-person to telehealth visits from 7.5 to 5.7 minutes (p<0.01), but male providers reported equal time with both modalities (6.0 min). No difference between females and males was noted during in-person (p=0.74) or telehealth visits (p=0.10). Physicians ranked discussing sexual function 7/10 on a priority scale. Topics included (by decreasing frequency) menopausal symptoms, vaginal dryness, decreased libido, and dyspareunia. Barriers to virtual discussions were not being queued by the pelvic exam (30%) and confirming patient privacy (26%). Notably, providers reported that patients felt comfortable and safe via telehealth. Providers reported they perform the majority of RRSOs with multiport laparoscopy (mean 78% of cases), though single port and robotics were common. A wide range of practice regarding the performance of hysterectomy with RRSO was noted: 2% of respondents performed hysterectomies with every RRSO, while 9% rarely performed them.Conclusions: Overall, telemedicine is now commonly used for RRSO consults. While many of these cases were delayed early in the pandemic, few providers are still delaying RRSO. A wide variety of practice was noted regarding surgical modality for RRSO and performance of hysterectomy. The use of telemedicine does not seem to inhibit discussions of sexual function, and most providers discuss sexual health in every RRSO consult. Importantly, the loss of the pelvic exam or private setting did not affect the time providers spent discussing sexual health.