Higher US COVID-19 hospitalizations are associated with compromised endometrial cancer care; 20% fewer patients were treated surgically during the first year of the pandemic (437)

Abstract

Objectives: To estimate the magnitude of postponed or canceled hysterectomies (hyst) for endometrial cancer (EC) associated with the COVID-19 pandemic.Methods: Hospitals submitting data to the Vizient database for the period from February 1, 2018, through June 30, 2021, provided the study population. We queried Vizient to identify all patients undergoing hyst for EC by month. The CDC declared a national emergency in February 2020; therefore, we defined a two-year pre-pandemic period as of February 1, 2018, through January 31, 2020; February 1, 2020, began the pandemic period. The mean number of monthly EC hyst for the 2-year pre-pandemic period established a baseline, and this was compared to the number of EC hyst per month during the pandemic. We calculated the “deficit” as the difference between the annual baseline and the number of hyst done during the first year of the pandemic. Monthly variance from baseline in EC hyst during the pandemic was graphed against the US COVID-19 hospitalization rates.Results: Total 314 hospitals reported data on 22,067 patients. The mean baseline (pre-pandemic) number of EC hyst/month was 582 (range: 539 to 644). In the first year of the pandemic period, the mean number of hyst/month was 466 (range: 350 to 537), a statistically significant decrease (p<0.0002). The monthly variance ranged from 42% in May 2020 to 4% in December 2020. The total deficit for the first 12 months of the pandemic was 1,440, a 20% decrease from the annual baseline. We were unable to determine how many EC patients did not have hyst due to personal COVID-19 infection. However, less than 4% of hospitalized patients in Vizient had both a diagnosis of active or history of COVID-19 and EC. Figure 1 shows that monthly deficits closely mirror the number of US COVID-19 hospitalizations. Conclusions: Hyst is the treatment of choice for the majority of women with EC; therefore, we conclude that the care of approximately one in five EC patients in the US who were surgical candidates was compromised during the first 12 months of the COVID-19 pandemic. Although this retrospective study did not demonstrate cause and effect, it is logical to consider that delivery of optimal EC care has been profoundly, adversely, affected by higher COVID-19 hospitalization rates, not primarily due to EC patients actually having COVID-19 infections. We propose that broader implementation of public health measures to decrease COVID-19 hospitalization might facilitate optimal care for a substantial number of EC patients.[NB at the time of abstract submission, for most major hospitals, data was complete through June 2021, too early to evaluate associations with the Delta variant. By the time of the SGO meeting, we anticipate data to be complete through the end of December 2021, providing insights related to the recent surge].