Pikkujämsä Hanna, Luukkaala Tiina, Nyberg Reita H, Louvanto Karolina
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.
Acta Obstet Gynecol Scand. 2024 Dec;103(12):2566-2575. doi: 10.1111/aogs.14981. Epub 2024 Oct 2.
COVID-19 and new guidelines during the pandemic affected the gynecologic cancer treatment pathways, resulting in recorded delays and modifications in the treatment protocols. The aim of this study was to determine the impact of the COVID-19 pandemic in one of the major gynecologic cancer care centers in Finland, Tampere University Hospital.
Our retrospective register study included 909 patients that were new gynecologic cancer cases (uterine, cervical, vulvar, vaginal, or ovarian) referred to the Tampere University Hospital Gynecologic Oncology Outpatient Clinic between March 17th, 2018, and March 15th, 2022. The patients were divided into two separate groups depending on their time of referral: time before COVID (March 17th, 2018, to March 15th, 2020), and during COVID (March 16th, 2020, to March 15th, 2022). These groups were compared in terms of patient characteristics, different cancer types and stages, symptoms, and treatment methods.
During the COVID-19 pandemic, patients generally suffered from cancer symptoms longer (p < 0.003) and were more likely to be overweight (p = 0.035). The improved multidisciplinary team meeting gave the patients a faster route to their first intervention during COVID (p < 0.05). An insignificant shift toward nonsurgical first interventions and non-curative intent was seen during COVID, but the multidisciplinary team treatment plans were mostly implemented accordingly on both eras. No decrease was seen in the number of new gynecologic cancer cases, and the one-year overall survival remained the same in both groups.
Overall, the COVID-19 pandemic did not significantly alter treatment pathways in gynecologic cancer care at Tampere University Hospital. The number of new patients and given treatments remained relatively stable. During COVID, access from referral to cancer treatment was significantly accelerated, which is likely confounded by changes to the multidisciplinary team protocol made in early 2021.
新冠疫情期间的新冠病毒疾病（COVID-19）及新指南影响了妇科癌症的治疗路径，导致治疗方案出现延误并有所修改。本研究的目的是确定COVID-19大流行对芬兰主要妇科癌症护理中心之一坦佩雷大学医院的影响。
我们的回顾性登记研究纳入了909例新诊断的妇科癌症患者（子宫癌、宫颈癌、外阴癌、阴道癌或卵巢癌），这些患者于2018年3月17日至2022年3月15日期间转诊至坦佩雷大学医院妇科肿瘤门诊。根据患者的转诊时间，将其分为两个独立的组：COVID之前的时间（2018年3月17日至2020年3月15日）和COVID期间（2020年3月16日至2022年3月15日）。对这些组在患者特征、不同癌症类型和分期、症状以及治疗方法方面进行了比较。
在COVID-19大流行期间，患者出现癌症症状的时间通常更长（p < 0.003），且超重的可能性更大（p = 0.035）。改进后的多学科团队会议使患者在COVID期间能更快地获得首次干预（p < 0.05）。在COVID期间，向非手术首次干预和非治愈性意图有不显著的转变，但两个时期的多学科团队治疗计划大多都得到了相应实施。新诊断的妇科癌症病例数量没有减少，两组的一年总生存率保持不变。
总体而言，COVID-19大流行并未显著改变坦佩雷大学医院妇科癌症护理的治疗路径。新患者数量和所给予的治疗相对保持稳定。在COVID期间，从转诊到癌症治疗的流程显著加快，这可能与2021年初多学科团队方案的改变有关。
