Mukherjee Amrita, Shammas Natalie, Xu Lanfang, Cannavale Kimberly L, Gilfillan Alec D, Szamreta Elizabeth A, Monberg Matthew, Hodeib Melissa, Chao Chun R
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, CA, United States.
Front Oncol. 2024 Mar 27;14:1290719. doi: 10.3389/fonc.2024.1290719. eCollection 2024.
The Coronavirus Disease 2019 (COVID-19) pandemic posed critical challenges in providing care to ovarian cancer (OC) patients, including delays in OC diagnosis and treatment initiation. To accommodate for delays in OC surgery, the Society of Gynecologic Oncology (SGO) recommended preferential use of neoadjuvant chemotherapy during the pandemic. The purpose of this study was to assess the association of the COVID-19 pandemic with neoadjuvant chemotherapy use in patients diagnosed with OC.
This retrospective cohort study included patients diagnosed with stage II-IV ovarian cancer of epithelial subtype between 01/01/2017-06/30/2021 at Kaiser Permanente Southern California (KPSC), a large integrated healthcare system in the United States. Ovarian cancer patients diagnosed between 2017-2020 were identified from KPSC's Surveillance, Epidemiology, and End Results (SEER)-affiliated cancer registry. Patients diagnosed in 2021 were identified from the electronic medical records (EMR) using ICD-10 diagnosis codes, followed by medical chart review to validate diagnosis and extract information on histology and stage at diagnosis. March 4, 2020 was used as the cut-off to define pre-pandemic and pandemic periods. Patients diagnosed with COVID-19 between OC diagnosis and treatment completion were excluded. Data on neoadjuvant chemotherapy use were extracted from the cancer registry and EMR, supplemented by chart review. Modified Poisson regression was used to evaluate the association of the pandemic with neoadjuvant chemotherapy use.
Of 566 OC patients, 160 (28.3%) were diagnosed in the pandemic period. Patients diagnosed in the pandemic period were slightly younger (mean age 62.7 64.9 years, p=0.07) and had a higher burden of Charlson comorbidities (p=0.05) than patients diagnosed in pre-pandemic period. No differences in time to treatment initiation were observed by pandemic periods. Neoadjuvant chemotherapy use was documented in 58.7% patients during the pandemic period compared to 47.3% in pre-pandemic period (p=0.01). After adjusting for covariates, patients diagnosed in the pandemic period were 29% more likely to receive neoadjuvant chemotherapy than patients diagnosed in pre-pandemic period [RR(95%CI): 1.29(1.12-1.49)].
Ovarian cancer patients diagnosed in the COVID-19 pandemic were more likely to receive neoadjuvant chemotherapy than patients diagnosed before the pandemic. Future research on patient outcomes and trends in the post-pandemic period are warranted.
2019年冠状病毒病（COVID-19）大流行在为卵巢癌（OC）患者提供护理方面带来了严峻挑战，包括OC诊断和治疗开始的延迟。为了适应OC手术的延迟，妇科肿瘤学会（SGO）建议在大流行期间优先使用新辅助化疗。本研究的目的是评估COVID-19大流行与OC诊断患者使用新辅助化疗之间的关联。
这项回顾性队列研究纳入了2017年1月1日至2021年6月30日期间在美国大型综合医疗系统南加州凯撒永久医疗集团（KPSC）被诊断为上皮亚型II-IV期卵巢癌的患者。2017 - 2020年期间被诊断为卵巢癌的患者从KPSC的监测、流行病学和最终结果（SEER）附属癌症登记处识别。2021年诊断的患者使用国际疾病分类第10版（ICD-10）诊断代码从电子病历（EMR）中识别，随后进行病历审查以验证诊断并提取诊断时的组织学和分期信息。2020年3月4日被用作界定大流行前和大流行期间的截止日期。在OC诊断和治疗完成之间被诊断为COVID-19的患者被排除。新辅助化疗使用的数据从癌症登记处和EMR中提取，并辅以病历审查。使用修正泊松回归来评估大流行与新辅助化疗使用之间的关联。
在566例OC患者中，160例（28.3%）在大流行期间被诊断。与大流行前诊断的患者相比，大流行期间诊断的患者年龄稍小（平均年龄62.7对64.9岁，p = 0.07）且Charlson合并症负担更高（p = 0.05）。不同大流行时期在开始治疗的时间上未观察到差异。大流行期间58.7%的患者有新辅助化疗使用记录，而大流行前为47.3%（p = 0.01）。在调整协变量后，大流行期间诊断的患者接受新辅助化疗的可能性比大流行前诊断的患者高29%[相对风险（95%置信区间）：1.29（1.12 - 1.49）]。
在COVID-19大流行期间被诊断的卵巢癌患者比大流行前诊断的患者更有可能接受新辅助化疗。有必要对大流行后时期的患者结局和趋势进行未来研究。
