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The optimal diagnostic tool and the implementation of effective treatment at the earliest possible stage of the procedure – in the case of ovarian cancer, these are the golden rules that can extend a woman’s life by up to several years. Unfortunately, effective therapy is hindered by SARS-CoV-2, which may influence diagnostic and therapeutic decisions. The Polish Society of Oncological Gynecology, in the interests of patients with ovarian cancer, has developed special guidelines to help doctors involved in treatment.
The key time of remission
Ovarian cancer, often referred to as the “silent, sneaky killer”, is a cancer that initially develops completely asymptomatically. Women are not aware of their disease and seeking appropriate specialist help usually delays diagnosis, which directly affects the poor prognosis. The situation is not improved by the lack of effective prophylaxis (screening).
Ovarian cancer is usually diagnosed at a high clinical stage, i.e. there are already metastases to other organs in the abdominal cavity. The chances of curing such an advanced neoplastic process are limited. Moreover, the disease is usually recurrent. In the treatment of patients with ovarian cancer, it is important to extend the time without disease symptoms and to ensure that the patient has an adequate quality of life during long-term treatment.
Ovarian cancer, despite constant progress in the diagnosis and therapy of neoplasms, remains a disease with poor prognosis. It most often affects women in the seventh decade of life, although among my patients there are also young people. In the treatment of ovarian cancer, we strive to maximize the duration of remission.
We achieve particularly good results in the case of patients with BRCA-dependent ovarian cancer, when it is possible to use treatment that maintains the effects of current chemotherapy, treatment with PARP inhibitors. It is connected with the necessity to perform a molecular test, preferably with the use of next-generation sequencing (the so-called NGS method) at an early stage of diagnosis. If the patient tolerates the treatment well, it should under no circumstances be discontinued.
Moreover, a pandemic cannot become a reason for not including newly diagnosed patients in such personalized treatment. Time matters, ovarian cancer will not wait for the COVID-19 vaccine – comments Prof. dr hab. n. med. Wiesława Bednarek, Department of Gynecology and Oncological Gynecology SPSK 1 in Lublin, Secretary of the Polish Society of Oncological Gynecology.
Oral maintenance therapy is associated with monthly visits to the oncology center for laboratory tests and three-monthly CT scans. In the situation of the COVID-19 epidemic, a major threat to patients is the possibility of stopping treatment by the attending physician, difficult contact with him or prolonged diagnostic procedures. It is extremely important to take care of hygiene in centers treating patients and to maintain the so-called “Crown-negative zones”.
In the first days of the epidemic, we received numerous phone calls from patients who were postponed for check-ups out of concern for their safety. There was a fear as to whether the treatment would be planned and whether the delayed treatment would have an impact on the effectiveness of treatment.
The patients’ response was fully understandable as ovarian cancer is an insidious disease where timing of treatment is crucial. However, despite the initial chaos, it turned out that the oncology centers found themselves in a new, difficult reality and took a number of steps to ensure that patients were properly protected.
Various solutions have been introduced, such as: teleporting and telephone contact with the attending physician and, if possible, the replacement of intravenous chemistry in a hospital with a therapy in tablets taken at home. We, as the Association, do everything in our power to ensure the safety of patients by delivering masks, visors and disinfectants to hospitals – says Barbara Górska, president of the Blue Butterfly Association.
The most important thing is to try to maintain the recommended intensity of treatment
Cancer patients are twice as likely to be infected with the coronavirus, according to researchers in Wuhan Province, and die four times more often if they develop COVID-19. Based on the experience of Chinese doctors, and at the same time knowing the Polish reality, the Polish Society of Oncological Gynecology has developed Recommendations for the Management of Patients with Female Genital Neoplasms during the SARS-CoV-2 pandemic. In the recommendations, apart from general guidelines based on the recommendations of the Chief Sanitary Inspectorate and the Ministry of Health, there are detailed points on the management of patients with ovarian cancer (LINK to recommendations).
The experience of Chinese and Italian doctors leaves no doubt that oncological patients are particularly at risk of developing serious complications as a result of SARS-CoV-2 infection. It is therefore necessary to take special precautions. However, they cannot influence the decision to start or suspend the therapy. In the case of ovarian cancer, we should strive to maintain the recommended treatment intensity, and thus implement the most effective treatment methods available at the earliest stage of the procedure.
It is worth considering the use of an oral drug in patients and prescribing it for a longer period than usual. In turn, when controlling patients, it is worth using telemedicine solutions more widely – summarizes Prof. dr hab. n. med. Jan Kotarski, Department of Gynecology and Oncological Gynecology SPSK 1 in Lublin, President of the Polish Society of Oncological Gynecology.
Already in the first weeks of the COVID-19 epidemic, we should draw conclusions from the limitations of the healthcare system in Poland and look for long-term solutions. Such a simple solution that solves many problems may be adding a tab with test results to the Internet Patient Account. Thanks to this, the patient will always have access to them.
For example, in a situation where she should not leave the house, she can send the doctor the results during the follow-up teleportation. This form of contact with a doctor could also work in the future. Many times, patients spend several hours on the way to the center, and then in the queue to the clinic, which could save – adds Elżbieta Kozik, president of the Polish Amazonki Ruch Społeczny association.