Good clinical practice advice for the management of patients with gynaecological cancer during the COVID-19 pandemic in Nigeria and other resource-constrained countries.

Kehinde S Okunade,Adeyemi A Okunowo,Rose I Anorlu,Ephraim O Ohazurike

doi:10.3332/ecancer.2020.1075

Abstract

The impact of the COVID-19 pandemic on healthcare services in settings with under-resourced health systems such as that of Nigeria is likely to be substantial in the coming months. The gynaecological oncology services still need to be prioritised as an essential core health service. There are increasing concerns from both physicians and patients regarding how to manage patients diagnosed with cancer during this pandemic as evidence suggests a substantial increase in the risk of COVID-19-related deaths amongst patients with cancer. However, we recognise that despite this great challenge, we must continue to provide the highest quality of care to the patients, whereas, at the same time, ensure adequate safety not only for the patients and their families but also for the entire oncology team. We advocate that due to the widespread travel restrictions and inability to refer patients for the highest level of care at this period, centres without radiotherapy facilities as seen in most resource-limited settings should always consider lower level care options such as the use of chemotherapy pending when there is a better access to these facilities. We, therefore, developed this good clinical practice advice to staff of the gynaecological oncology unit in the centre and other resource-constrained settings for the management of patients with gynaecological cancer during the COVID-19 pandemic.

Highlights

In January 2020, the current novel coronavirus disease 2019 (COVID-19) outbreak was declared as a Public Health Emergency of International Concern by World Health Organisation [1]
It is imperative that we explore options that reduce the number of procedures or surgical interventions that may be associated with prolonged operative time, risk of major blood loss necessitating transfusion with blood products, risk of infection to the medical personnel or admission to the intensive care unit (ICU) [8]
Due to the widespread travel restrictions and inability to refer patients for the highest level of care, centres without radiotherapy facilities, as seen in most resource-limited settings, should always consider a lower level care options such as the use of chemotherapy pending when there is a better access to these facilities for the patients [24]

Summary

Introduction

Publication costs for this article were supported by ecancer (UK Charity number 1176307). The decision to commence treatment should be made based on the type and stage of the disease, medical condition of the patient, COVID-19-associated risks and available logistic support including adjuvant treatment services such as radiotherapy and chemotherapy [7]. To carry out surgical procedures in an orderly and safe manner, an acuity scale is suggested to guide gynaecological oncologists whether to postpone or perform surgical procedures during the COVID-19 pandemic [15, 17] This includes conditions that are not life-threatening (pre-invasive lesion of cervix or endometrium) and for which surgery can be postponed for a few weeks or months. Evidencebased protocols focusing on the surgical management of cancer patients should be adopted, i.e., the enhanced recovery after surgery (ERAS) protocols [19,20,21]

Surgical procedures

Conclusion

17. COVID-19