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(Maastricht University), Willemien J. van Driel(The Netherlands Cancer Institute), B.F.M. Slangen(Maastricht University), R Kruitwagen(Maastricht University), Michel W.J.M. Wouters(Leiden University Medical Center), Astrid Baalbergen(Reinier de Graaf Hospital), A Dorien ten Cate(Spaarne Gasthuis), A.L. Aalders(Rijnstate Hospital), A. van der Kolk, A.J. Kruse(Isala), A.M.L.D. van Haaften-de Jong(Haga Hospital), A.M.G. van de Swaluw(Refaja Ziekenhuis), B.A.J.T. Visschers, C.C.N. Buis(Ziekenhuis Nij Smellinghe), Cornelis G. Gerestein(Meander Medisch Centrum), C.M.W.H. Smeets(Slingeland Ziekenhuis), Dorry Boll(Catharina Ziekenhuis), Rafli van de Laar(VieCuri Medisch Centrum), D.H. Ngo(Elkerliek Ziekenhuis), Elvira M. Davelaar(Lange Land Ziekenhuis), E.A. Ooms(Rode Kruis Ziekenhuis), E.B.L. van Dorst(University Medical Center Utrecht), Channa E. Schmeink(St. Anna Ziekenhuis), E.J.M. van Es(St.Jans Gasthuis Weert), Eva Maria Roes(Erasmus MC Cancer Institute), F.A. Ten Cate(Spaarne Ziekenhuis), Fleur E.M. Rijcken(Alrijne Ziekenhuis), F.M.R. Rosier-van Dunné(Tergooi), Guus Fons(Academic Medical Center), Gunther Jansen, Harold R Verhoeve(OLVG), H.T.C. Nagel(Medisch Centrum Haaglanden), H.H. Keizer(Medisch Centrum Leeuwarden), H.P.M. Smedts(Amphia Ziekenhuis), Inge Ebisch(Canisius-Wilhelmina Ziekenhuis), Jonas van de Lande(Dutch Institute for Clinical Auditing), J.A. Louwers, Justine M. Briët(Dutch Institute for Clinical Auditing), Jolien de Waard(Leiden University Medical Center), Jeroen Diepstraten(Dutch Institute for Clinical Auditing), Jos H.A. Vollebergh, Irene A.M. van der Avoort, J.E.W. Van Dijk, J Lange(Maastricht University), Jan Willem Mens(Erasmus MC Cancer Institute), Katja N. Gaarenstroom, K. Overmars(Maastricht University), Leonie C. De Vries, Laura Hofman, Lidewij R. Bartelink, Martijn Huisman, M.B. Verbruggen, Martine De Vos, Margriet A. Huisman(Leiden University Medical Center), Marjolein Kleppe(Dutch Institute for Clinical Auditing), Muriel van den Hende(Dutch Institute for Clinical Auditing), Maaike A. van der Aa(Leiden University Medical Center), Miriam Wüst(Dutch Institute for Clinical Auditing), Messina Baas, M.J.A. Engelen, E.C.A.H. Scheers, M.W.G. Moonen-Delarue, Ming Y. Tjiong, Ninke Leffers, N Reesink, P.J. Timmers, P. Kolk, P.M.L.H. Vencken, Refika Yigit, Roelof A. J. Smit, Steven M. Westenberg, S.F.P.J. Coppus, Tanja C. Stam(Medisch Centrum Haaglanden), Tineke Schukken, W.M. van Baal, W. Minderhoud-Bassie(Leiden University Medical Center), Y.W.C.M. van der Plas-Koning, Maaike A. van der Aa
Gynecologic Oncology
February 21, 2022
10.1016/j.ygyno.2022.02.013
Cited by 33Open Access
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Abstract

OBJECTIVE: The 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. METHODS: This 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. RESULTS: A 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. CONCLUSIONS: The 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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