Gynecologic Cancer management in the Midst of COVID-19 Pande
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The COVID-19 pandemic has changed the world. It created unique challenges and distress for both patients with a cancer diagnosis as well as providers who care for them. There is a need to reduce the risk of cancer patients contracting the infection, avoid treatment complications whilst making the best use of resources which includes the protection of Health care workers in the process. This pandemic will last for a period of time and our lives after the pandemic will never be the same.

Indication for surgery is classified as elective/non-urgent, semi-urgent, and urgent/emergent. Most gynecologic cancer cases are semi-urgent surgeries, second only to trauma cases and surgical emergencies. Accurate triage is critical to preserving resources and protecting staff and patients. Test for COVID-19 prior to surgery is recommended.

In the case of Chemotherapy, a limit on frequency of infusions is recommended, to avoid weekly infusions. Consider oral therapies in place of infusion-based treatments when appropriate. Consider less frequent dosing intervals regimen. Consider single agent therapy or holding cancer directed therapy for patients >65 years old.

For radiotherapy, patients with rapidly proliferating tumours are in the highest priority group. Do consider hypofractionation (increase dose per day and reduce the number of fractions) to reduce the number of times necessary for patients to visit the hospital for treatments.

Alternative treatment
Patients with grade 1 endometrial cancer can be considered for conservative treatment with non-surgical options, including systemic hormonal therapy or medicated intrauterine devices. In patients with advanced ovarian cancer, consider neo-adjuvant chemotherapy until crisis is resolved and consideration of surgery at a later time.