Introduction
Following the identification of the novel coronavirus and its ensuing COVID-19 disease in late 2019, it quickly became a global pandemic. As different countries faced different challenges, new guidance was rapidly published on how to treat and control the spread of the disease. Whilst it is clear that some disparities do exist within the literature, it is evident that there are many similarities in how departments responded to this pandemic and this has been true within the field of gynaecological oncology. Whilst it is still too early for the publishing of large trials, this article aims to summarise the current available global guidance for the management of gynaecological oncology patients throughout this crisis.
Oncology patients are at risk of greater mortality as a consequence of contracting coronavirus, however do not appear to be at a higher risk of contracting the illness, with no evidence of increased incidence within this population. The increased risk of mortality is due to the immunosuppressive state of malignancy as well as current or previous administration of chemotherapeutic agents (1). A study from China has shown that the mortality of COVID-19 with a current cancer is 7.6%, compared to 1.4% if no comorbidities present but was less than having comorbidities such as cardiovascular disease (13.2%), diabetes (9.2%), hypertension (8.4%) and chronic respiratory disease (8%)(2).
Although delaying surgery due to concerns about patients contracting COVID-19 peri-operatively, reduced intensive care facilities, reduced staff, reduced theatre availability and reducing risk to staff members and current patients, this needs to be offset with the risk of a rapidly progressing cancer where delay could lead to severe complications and disease progression to the point of affecting surgical cure and therefore ultimately patient prognosis.
There are several identified themes that remain common and consistent between different countries and are applicable to gynaecological oncology as a whole.
  1. Reduce transmission
  2. Managing limited resources including staffing
  3. Treatment prioritisation and continuation of cancer surgery
  4. Exploration of alternative therapy