Diving into the COVID-19 Pandemic’s Impact on Ovarian Cancer, Remission Rates

In part 1 of an interview with The American Journal of Managed Care^®, Chun Chao, PhD, MS, cancer epidemiologist at Kaiser Permanente Southern California, explores the impact of the COVID-19 pandemic on oncology care, particularly for patients with ovarian cancer.

She also outlines the objectives of her study, "Clinical Remission Rates in Patients With Epithelial Ovarian Cancer Before and After the Onset of the COVID-19 Pandemic in an Integrated Healthcare Delivery System."

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Could you begin by discussing the impact of the COVID-19 pandemic on cancer screening, diagnosis, and treatment, especially for ovarian cancer?

Oncology care has definitely been affected in a significant way by the pandemic, and there are several reasons for that. As we know, several of the cancer types—there's a sense of urgency to them. Also, oncology care can sometimes be very complex, involving multidisciplinary experts or physicians, so the care pathways are very multidisciplinary. There's also a demand for frequent contact between the patient and the health care providers.

Patients with cancer, while undergoing cancer treatment, are somewhat immunosuppressed, so they are a rather vulnerable population. Because of all these reasons, you can imagine how the cancer care was really affected by the pandemic.

There are several studies from the US, as well as Europe, that show that there's a reduction in cancer screening rates, the number of cancers diagnosed in the pandemic year vs prior years, and, also, the number of treatments. When you compare the pre-pandemic era vs the pandemic, you see fewer cancer treatments being provided in the pandemic era.

When it comes to ovarian cancer, ovarian cancer is considered a pretty aggressive cancer; over two-thirds were diagnosed at advanced stages. For ovarian cancer, there are also studies that show a significant delay in getting treatment, so treatment initiation, as well as treatment being canceled, in the early stage of the pandemic.

Also, we have consistently seen studies report the altered management approach for patients with ovarian cancer. To that end, I want to mention that our guideline bodies, nationally and internationally, highlight the use of neoadjuvant chemotherapy in the pandemic era, so that may be the underlying reason why we see altered management approaches for ovarian cancer.

What was the objective of your study? Why did you decide to investigate this?

Like I mentioned earlier, ovarian cancer management has been altered during the COVID-19 pandemic era. This study was started in the middle of the pandemic, and we thought it would be important to understand how management approaches of ovarian cancer have evolved. Also, what were the short-term outcomes that these patients experienced with these altered approaches?

It is possible we may have another pandemic if a newly-evolved virus arises in the future. So, it is important to learn from the experience of this past COVID-19 pandemic. That's why we decided to conduct this evaluation. The objectives of our study are several. We wanted to compare the management approaches before and after the onset of the pandemic.

One thing is the physician visits, whether that's telehealth or in-person, does that remain stable? Also, the monitoring for the chemotherapy toxicity. Was that done to the same level of vigilance compared with the pre-pandemic level?

Also, we want to look at if patient outcomes are actually comparable with all these alterations in management. You have increased use of neoadjuvant chemotherapy, you have increased use of telehealth, but are patients still achieving remission as in the pre-pandemic era?