key: cord-0734473-8ckff3oz
authors: Frey, Melissa K.; Blank, Stephanie V.
title: Coronavirus concerns: What do women with gynecologic cancer need to know during the COVID-19 crisis?
date: 2020-04-24
journal: Gynecol Oncol
DOI: 10.1016/j.ygyno.2020.04.697
sha: 0233c2c0ceb5d11ffcbdc25965ac1545b6580679
doc_id: 734473
cord_uid: 8ckff3oz

• COVID-19 is likely uniquely unsettling to gynecologic oncology patients. • Resources addressing the questions of patients with cancer during the COVID-19 crises remain scarce. • Women with gynecologic cancer were invited to participate in a webinar on COVID-19 and cancer concerns. • We share participant questions to understand concerns and utilize this knowledge to improve patient education and support.

reporting the evolution of a new pathogen, in its very earliest stages, in real time. [1, 2] This is especially applicable to cancer care during the COVID-19 pandemic. Early data describing patient cohorts in China suggest that individuals with cancer may have higher rates of COVID-19-related complications, including admission to intensive care units, need for mechanical ventilation and death. [3, 4] However, such studies are limited by small sample size, heterogeneous cancer types and several possible confounding variables including noncancer comorbidities. Oncology providers face difficult decisions, balancing plausible risks of COVID-19 infection for cancer patients with the recognized consequences of not treating cancer in an effective or timely manner. [5] Several medical societies have provided guidance for oncology providers during the COVID-19 pandemic. [6] [7] [8] [9] [10] However, resources addressing the questions of patients with cancer during the COVID-19 crises remain scarce, and, in fact, at present, there is a dearth of reports of patients' perspectives on the issue. With this in mind, SHARE and the Foundation for Women's Cancer (FWC) hosted a webinar on April 10, 2020, entitled "What the COVID-19 Crisis Means for Women with Gynecologic Cancer." SHARE is a nonprofit organization that enables informed survivors of ovarian and breast cancer to help women facing these diseases through its toll-free national helplines, in-person support groups, educational programs and advocacy with a focus on the medically underserved. The FWC is a nonprofit organization dedicated to increasing research, education and awareness about gynecologic cancer risk, prevention, early detection and optimal treatment and is the official foundation of the Society of Gynecologic Oncology (SGO). SHARE and the FWC sent online webinar invitations to women with prior or current gynecologic through their email distribution lists and the registration link was posted on social media.

The webinar consisted of 30 minutes of didactic presentations by gynecologic oncologists with accompanying slides covering the following topics: COVID-19 basics, early data on COVID-19 in people with cancer, disruptions in clinical care including follow-up visits, cancer screening, laboratory tests, imaging, chemotherapy, radiation therapy and surgery, the role of telehealth, decision-making and advanced directives, recommendations to minimize risk, wellness during COVID-19 and coping strategies. The didactic portion was followed by a 30-minute question and answer session. Participants were invited to share questions through an online portal prior to and during the webinar. We aim to share Journal Pre-proof J o u r n a l P r e -p r o o f these questions so that those providing oncologic care to women with gynecologic cancers can understand the concerns and queries of their patients and utilize that knowledge to improve patient education and support.

Two hundred and forty-seven women registered for the webinar and 138 participated in the live webinar. Participants submitted 176 questions (147 questions prior to the webinar and 29 during the webinar). The most common request was for general information on the relationship between cancer and COVID-19 infection, and many participants specifically asked whether prior or current cancer and cancer-related treatment increase the risk of COVID-19 infection or having a serious outcome if infected.

There were a multitude of questions regarding treatment interruptions, delays and cancellations, specifically with regard to surgery, chemotherapy, laboratory testing and surveillance visits, including screening cancellations for BRCA1/2 mutation carriers and whether someone being evaluated for possible recurrence was considered "non-essential." There was worry about the safety of non-cancelled visits, as well as several questions related to concerns about being on PARP inhibitors: whether risk is increased, how to manage visit cancellations, whether to stop the treatment. Other topics of concern to participants included how best to "protect myself," request for coping strategies and support programs, financial navigation and medical queries (port flush, taking ibuprofen) ( Figure 1 ). Additionally, there was concern expressed about the safety of a woman with a cancer history being a health care worker on the frontline. The participation from women with prior and current gynecologic cancer through this webinar offers gynecologic oncology care providers a glimpse into the questions and concerns of our patients. The COVID-19 pandemic is likely uniquely unsettling to gynecologic oncology patients; their treatments are interrupted, surgeries cancelled, regular oncology evaluations rescheduled and the relationship between COVID-19 and cancer remains unclear. Furthermore, prior literature has established that women with ovarian cancer consider communication between patient and physicians essential [11] [12] [13] [14] [15] . Oncologists are facing unprecedented times. As providers of gynecologic oncology care, it is imperative that we remain

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