Impact of the COVID-19-pandemic on patients with gynecological malignancies undergoing surgery: A Dutch population-based study using data from the ‘Dutch Gynecological Oncology Audit’

Marc Daniël Algera ,J.E.W Van Dijk,C.M.W.H Smeets,N Reesink,H.T.C Nagel,M.W.G Moonen-Delarue,W.M Van Baal,E.B.L Van Dorst,B.A.J.T Visschers,E.A Ooms,S.F.P.J Coppus,F.M.R Rosier-Van Dunné,W.J Van Driel,E.C.A.H Scheers,J.A Louwers,A Van Der Kolk,P.M.L.H Vencken,C.G Gerestein,M Van Der Aa,A.M.G Van De Swaluw,H.H Keizer,I.M.W Ebisch,M.J.A Engelen,Y.W.C.M Van Der Plas-Koning,R.A Smit,H.P.M Smedts,P Kolk,A.M.L.D Van Haaften-De Jong,M.B Verbruggen,K.N Gaarenstroom,A.D Ten Cate,K Overmars,Justine M Briët ,Messina Baas ,Laura Hofman ,Arnold‐Jan Kruse ,Jos H.a Vollebergh ,Petra Timmers ,Brigitte Slangen ,Fleur E.m Rijcken ,Dorry Boll ,Miriam Wüst ,Steven M Westenberg ,Ninke Leffers ,Michel W.j.m Wouters ,Guus Fons ,Tineke Schukken ,Gunther Jansen ,J Lange ,Judith De Waard ,Rfpm Kruitwagen ,T Stam ,Irene A.m Van Der Avoort ,Elvira M Davelaar ,Frances Cate ,Rafli Van De Laar ,Channa E Schmeink ,J.w Mens ,Ming Y Tjiong ,Marjolein Kleppe ,Astrid Baalbergen ,Jeroen Diepstraten ,Dat Ngo ,Margriet A Huisman ,Eva Maria Roes ,C Buis ,Willy Minderhoud-Bassie ,Jonas Van De Lande ,Anette L Aalders ,Leonie C De Vries ,Muriel Van Den Hende ,Harold R Verhoeve ,Lidewij R Bartelink ,Mc Vos ,Euctr Es ,Refika Yigit ,Maaike A.p.c Van Ham

doi:10.1016/j.ygyno.2022.02.013

Abstract

ObjectiveThe COVID-19-pandemic caused drastic healthcare changes worldwide. To date, the impact of these changes on gynecological cancer healthcare is relatively unknown. This study aimed to assess the impact of the COVID-19-pandemic on surgical gynecological-oncology healthcare. MethodsThis population-based cohort study included all surgical procedures with curative intent for gynecological malignancies, registered in the Dutch Gynecological Oncology Audit, in 2018–2020. Four periods were identified based on COVID-19 hospital admission rates: ‘Pre-COVID-19’, ‘First wave’, ‘Interim period’, and ‘Second wave’. Surgical volume, perioperative care processes, and postoperative outcomes from 2020 were compared with 2018–2019. ResultsA total of 11,488 surgical procedures were analyzed. For cervical cancer, surgical volume decreased by 17.2% in 2020 compared to 2018–2019 (mean 2018–2019: n = 542.5, 2020: n = 449). At nadir (interim period), only 51% of the expected cervical cancer procedures were performed. For ovarian, vulvar, and endometrial cancer, volumes remained stable. Patients with advanced-stage ovarian cancer more frequently received neoadjuvant chemotherapy in 2020 compared to 2018–2019 (67.7% (n = 432) vs. 61.8% (n = 783), p = 0.011). Median time to first treatment was significantly shorter in all four malignancies in 2020. For vulvar and endometrial cancer, the length of hospital stay was significantly shorter in 2020. No significant differences in complicated course and 30-day-mortality were observed. ConclusionsThe COVID-19-pandemic impacted surgical gynecological-oncology healthcare: in 2020, surgical volume for cervical cancer dropped considerably, waiting time was significantly shorter for all malignancies, while neoadjuvant chemotherapy administration for advanced-stage ovarian cancer increased. The safety of perioperative healthcare was not negatively impacted by the pandemic, as complications and 30-day-mortality remained stable.

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