Table 4. Recommendations for epithelial ovarian cancer care during the COVID-19 pandemic.
| Priority | Patient's status | Management |
|---|---|---|
| Newly diagnosed ovarian cancer | ||
| A | Suspected ovarian cancer with symptoms indicating bowel obstruction/perforation, massive ascites, or peritonitis | Assessment should be performed as soon as possible. |
| B | Suspected ovarian cancer with no symptom and looks confined to pelvis | For presumed early stage ovarian cancer according to salpingo-oophorectomy, restaging surgery can be deferred from 6–8 weeks. |
| B | Suspected ovarian cancer with no symptom and looks spread beyond pelvis | Delaying interval debulking surgery beyond 3–4 cycles of neoadjuvant chemotherapy should be considered. |
| Choose regimens scheduled with the fewest infusion visits. | ||
| Consider lower dosing intensity and less myelosuppressive regimens to reduce neutropenia. | ||
| Avoid the prescription of dose-dense, intraperitoneal, and HIPEC regimens. | ||
| B | After 3 cycles neoadjuvant chemotherapy in suspected advanced stage ovarian cancer | Consider extending the chemotherapy plan to 6 cycles before the interval cytoreductive surgery in women who have already started neoadjuvant chemotherapy. |
| A | Suspected postoperative complications (e.g. anastomotic leak) | Assessment should be performed as soon as possible. |
| B | Incidentally found ovarian cancer | For presumed early stage ovarian cancer according to salpingo-oophorectomy, restaging surgery can be deferred from 6–8 weeks. |
| If residual suspected, reoperation should be performed. | ||
| Early stage (I–IIA) ovarian cancer requiring postoperative adjuvant chemotherapy | ||
| A | High-grade serous/endometrioid | Adjuvant chemotherapy should be performed as soon as possible. |
| B | Non-high-grade serous/endometrioid | Adjuvant chemotherapy can be an option, but should be considered less essential and discussed with the patient about minimizing the infusion visits. |
| Adjuvant chemotherapy in advanced stage ovarian cancer | ||
| A | High-grade serous/endometrioid | Adjuvant chemotherapy should be performed as soon as possible. |
| A | High-grade serous with BRCA mutation | In patients who have a BRCA mutation and are PARP naïve, consider rucaparib monotherapy in situations where platinum therapy cannot be given. |
| B | Clear cell or mucinous tumor | Adjuvant chemotherapy can be an option, but should be considered less essential and discussed with the patient about minimizing the infusion visits. |
| C | Low-grade serous tumor | Consider deferring the adjuvant therapy as possible. |
| C | After upfront adjuvant chemotherapy | Consider deferring the maintenance chemotherapy as possible. |
| If utilizing PARPi maintenance therapy, consider the risk of the immunosuppression and exposure to COVID-19 during infusion. | ||
| Follow-up visit | Routine surveillance of asymptomatic patients should be postponed as possible. | |
| Utilize telemedicine and reduce the frequency of in-person evaluation. | ||
| C | Patients with PARPi maintenance | Most can be managed through telemedicine with scheduled blood tests and imaging done close to home. |
| C | Patients with bevacizumab maintenance | If facilities exist to continue, supervision can be performed by telemedicine, ensuring BP and urinalysis are monitored. |
| Recurrent disease | Choice of therapy should minimize exposure to other contacts, risk from therapy, and prognosis. | |
| B | Symptomatic platinum-sensitive recurrent disease | Adjuvant chemotherapy can be an option, but should be considered less essential and discussed with the patient about minimizing the infusion visits. |
| C | Symptomatic platinum-resistant recurrent disease | Non platinum-based regimen are low priority and should be used after careful review of the risk/benefit. |
| C | Symptomatic slowly growing recurrent disease | Decision should be based on clinical judgement. |
| C | Asymptomatic recurrent disease | Decision should be based on clinical judgement. |
| Special situation | ||
| C | Risk-reducing salpingo-oophorectomy for genetic predisposition to gynecological cancer | Consider deferring the surgery as possible. |
COVID-19, coronavirus disease 2019; BRCA, breast cancer gene; BP, blood pressure; HIPEC, hyperthermic intraperitoneal chemotherapy; PARPi, poly ADP ribose polymerase inhibitor.