Utilization of the healthcare system by gynecologic oncology patients during the SARS-CoV-2 pandemic surge in New York City

Abstract

Objectives:COVID-19 is characterized by rapid human-to-human transmission via contaminated respiratory droplets and therefore presents unique challenges in all aspects of healthcare delivery. This is especially true for patients with conditions, such as gynecologic cancer, which require frequent interface with healthcare centers. To further decrease the risk of exposure to these patients, alternate models of care delivery have been implemented and quickly adopted by medical centers. We sought to report the impact of modifications to traditional gynecologic cancer care at our institution.Methods:We identified women with suspected or confirmed gynecologic malignancy, age 18 or older, who received care at Montefiore Medical Center between March 16, 2020 and June 7, 2020; these dates reflect a series of executive orders issued by the governor of New York allowing the State Commissioner of Health to cancel elective procedures at hospitals, ambulatory surgery centers, and in the outpatient setting. Clinical data was abstracted from each patient's chart. Patients with incomplete treatment records were excluded.Results:A total of 111 women were identified to be undergoing active treatment and were included in our analysis, representing a total of 703 virtual or in-person patient encounters. More televisit encounters were performed compared to in-person encounters (209 vs 153). The average number of televisits per patient was significantly greater than the average number of in-person outpatient visits per patient (1.88±0.28 vs 1.38±0.42, p=0.047). Other encounters included 173 outpatient laboratory encounters, 112 outpatient radiology encounters, 30 emergency department encounters, 23 hospitalizations, and 3 ambulatory surgeries. Per patient, the median number of interactions was 5 (interquartile range 3-10). Patients with endometrial cancer (n=38) were more likely to be seen in person at least once in an outpatient visit than those with ovarian cancer (n=57) (OR 3.56, 95% CI 1.50-8.43). No significant difference between endometrial and ovarian cancer was seen in other types of encounters, including televisits (OR 0.94, 95% CI 0.32-2.74), inpatient admissions (OR 0.60, 95% CI 0.22-1.70), emergency room encounters (OR 0.77, 95% CI 0.28-2.09), ambulatory radiology encounters (OR 0.67, 95% CI 0.30-1.55), or ambulatory laboratory encounters (OR 0.96, 95% CI 0.42-2.24).Conclusions:The majority of patient encounters for gynecologic cancer at our institution during the SARS-COV-2 pandemic surge were conducted by telemedicine. Prior to the pandemic, telemedicine was not an active method of cancer care delivery within our institution. We predict that gynecologic oncology practice patterns will shift to include telemedicine as an integral part of patient care, even after SARS-COV-2 is no longer prevalent in the community.