Pandemic paradox: Shorter times from consult to gynecologic oncology treatment during COVID-19

Objectives: In response to the novel coronavirus (COVID-19) pandemic, healthcare systems and providers have made rapid adjustments to the delivery of patient care. Data continues to emerge on how the pandemic and responses to it affect diagnosis, management and outcomes for oncologic patients. The aim of this study is to investigate the impact of COVID-19 on time to consult and time to treatment in patients with newly diagnosed gynecologic malignancy. Methods: This was an institutional review board (IRB)-exempt retrospective case-control study. Pathology records from 3/2020 to 9/2020 were used to identify patients newly diagnosed with gynecologic malignancy during the COVID-19 pandemic. These cases were compared to historical controls who were diagnosed with gynecologic cancer between 3/2019 and 9/2019, prior to the pandemic. Baseline characteristics, including age, race/ethnicity, primary language, health insurance coverage, referral source, comorbidities, tumor site, and disease stage were compared between the groups using chart review. The primary outcomes evaluated were time from initial presentation to gynecologic oncologist consult, and time from consult to initial treatment. Treatment modality was assessed as a secondary outcome. Statistical analysis was performed using t-test and Chi-square test. Results: The study cohort included 143 patients: 71 newly diagnosed with gynecologic malignancy during the pandemic and 72 historical controls. Although the two groups were largely similar at baseline, higher rates of cervical cancer (14.1 vs 5.6%; p=0.01) and more advanced disease (33.8% with Stage III and IV disease compared to 20.8%; p=0.007) were observed in patients diagnosed during the pandemic. There was no difference in mean time from initial presentation to consult (27.9 vs 35.4 days; p=0.2) or in the proportion of patients who had gynecologic oncologist consultation within 30 days (73.9 vs 65.3%; p=0.1). A significantly greater portion of patients diagnosed during COVID-19 received treatment within 30 days or less of consultation (82.4% vs 66.7%; p=0.006). In both groups, the majority of patients underwent surgery, however other treatment modalities were more commonly employed in patients diagnosed during the pandemic (25.0 vs 10.6%; p=0.0001). Although the two groups were similar with regards to the proportion of patients who received other treatment modalities within 30 days of consult (88.2 vs 85.7%; p=0.8), a greater proportion of patients diagnosed during the pandemic underwent surgery within 30 days or less from consultation (80.3 vs 64.4%; p=0.02). Download : Download high-res image (84KB) Download : Download full-size image Conclusions: Patients newly diagnosed with gynecologic malignancy during the pandemic had shorter times to treatment, and this trend was associated with a greater proportion of patients undergoing surgery within 30 days of consultation. Long-term integration of strategies adopted during COVID-19, such as telemedicine and prioritization of surgical cases, could expedite care even after the pandemic and potentially improve patient outcomes.