NewYork-Presbyterian Weill Cornell Medicine, USA.
NewYork-Presbyterian Weill Cornell Medicine, USA.
Gynecol Oncol. 2020 Nov;159(2):470-475. doi: 10.1016/j.ygyno.2020.09.005. Epub 2020 Sep 25.
BACKGROUND: New York City was among the epicenters during the COVID-19 pandemic. Oncologists must balance plausible risks of COVID-19 infection with the recognized consequences of delaying cancer treatment, keeping in mind the capacity of the health care system. We sought to investigate treatment patterns in gynecologic cancer care during the first two months of the COVID-19 pandemic at three affiliated New York City hospitals located in Brooklyn, Manhattan and Queens. METHODS: A prospective registry of patients with active or presumed gynecologic cancers receiving inpatient and/or outpatient care at three affiliated New York City hospitals was maintained between March 1 and April 30, 2020. Clinical and demographic data were abstracted from the electronic medical record with a focus on oncologic treatment. Multivariable logistic regression analysis was explored to evaluate the independent effect of hospital location, race, age, medical comorbidities, cancer status and COVID-19 status on treatment modifications. RESULTS: Among 302 patients with gynecologic cancer, 117 (38.7%) experienced a COVID-19-related treatment modification (delay, change or cancellation) during the first two months of the pandemic in New York. Sixty-four patients (67.4% of those scheduled for surgery) had a COVID-19-related modification in their surgical plan, 45 (21.5% of those scheduled for systemic treatment) a modification in systemic treatment and 12 (18.8% of those scheduled for radiation) a modification in radiation. Nineteen patients (6.3%) had positive COVID-19 testing. On univariate analysis, hospital location in Queens or Brooklyn, age ≤65 years, treatment for a new cancer diagnosis versus recurrence and COVID-19 positivity were associated with treatment modifications. On multivariable logistic regression analysis, hospital location in Queens and COVID-19 positive testing were independently associated with treatment modifications. CONCLUSIONS: More than one third of patients with gynecologic cancer at three affiliated New York City hospitals experienced a treatment delay, change or cancellation during the first two months of the COVID-19 pandemic. Among the three New York City boroughs represented in this study, likelihood of gynecologic oncology treatment modifications correlated with the case burden of COVID-19.
背景：纽约市是 COVID-19 大流行期间的重灾区之一。肿瘤医生必须权衡 COVID-19 感染的潜在风险与延迟癌症治疗的公认后果，同时考虑医疗保健系统的能力。我们旨在研究 COVID-19 大流行的头两个月期间，在位于布鲁克林、曼哈顿和皇后区的三家附属纽约市医院中妇科癌症治疗的模式。
方法：在 2020 年 3 月 1 日至 4 月 30 日期间，我们对在三家附属纽约市医院接受住院和/或门诊治疗的活跃或疑似妇科癌症患者进行了前瞻性登记。从电子病历中提取临床和人口统计学数据，重点关注肿瘤治疗。我们还探索了多变量逻辑回归分析，以评估医院位置、种族、年龄、合并症、癌症状态和 COVID-19 状态对治疗修改的独立影响。
结果：在 302 名妇科癌症患者中，有 117 名（38.7%）在 COVID-19 大流行的头两个月中经历了与 COVID-19 相关的治疗修改（延迟、改变或取消）。64 名患者（计划手术患者的 67.4%）手术计划发生了与 COVID-19 相关的修改，45 名患者（计划全身治疗患者的 21.5%）全身治疗发生了修改，12 名患者（计划放疗患者的 18.8%）放疗发生了修改。19 名患者（6.3%）COVID-19 检测呈阳性。在单变量分析中，位于皇后区或布鲁克林的医院位置、年龄≤65 岁、新诊断癌症的治疗与复发以及 COVID-19 阳性与治疗修改相关。在多变量逻辑回归分析中，位于皇后区的医院位置和 COVID-19 阳性检测结果与治疗修改独立相关。
结论：在三家附属纽约市医院的妇科癌症患者中，有超过三分之一的患者在 COVID-19 大流行的头两个月经历了治疗延迟、改变或取消。在这项研究中代表的三个纽约市行政区中，妇科肿瘤治疗修改的可能性与 COVID-19 的病例负担相关。
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