Table 4.

Main characteristics of studies including data on cervical cancer treatment.

	First author and year	Country	Data source (and target population)	Sample size	Outcome measure	Main findings	aNOS score (max 7)
1	(Altın et al., 2020)	Turkey	Web-based survey among gynecologic oncologists affiliated to the Turkish Society of Gynecologic Oncology	70	Number of standard surgeries, delay, referral to other hospitals, radiotherapy. Stratification for cancer stage	Overall, 97.1% of surveyees responded that cancer management changed during the pandemic (for all gynecological cancers). 58% of surgeons continued to operate microinvasive cervical cancer, while 33.3% delayed surgery. Standard surgery (67.1%) and delay (20%) were the two leading responses for early-stage cervical cancer. Primary RT or chemo-RT was applied without delay to most of the locally advanced cervical cancer patients, but hypo-fractional dose (57.1%) was preferred to standard dose (27.1%), in order to reduce the number of hospital visits. 67.1% of surgeons continued to perform surgery or administered CT/RT to metastatic or recurrent cervical cancer patients.	4
2	(Desta et al., 2021)	Ethiopia	Population-level healthcare administrative data	NR	Number of women with cervical lesions who received treatment	During the second quarter of 2020, there was a decrease in number of women aged 30–49 years with cervical lesion and received treatment (−85.0%; 20 vs. 3), compared to the same period of 2019.	6
3	(Hathout et al., 2021)	United States	Medical records from four cancer centers	15	Days of treatment delays	All patients with cervical cancer received their treatments as planned; however, four of 15 patients (26.7%) had a treatment interruption during their course. Two patients experienced significant delays (>20 days) owing to COVID-19 infection and the other two patients had treatment interruptions due to non-COVID medical problems.	4
4	(Istrate-Ofițeru et al., 2021)	Romania	Medical records from Obstetrics and Gynecology Clinics patients with pathological Pap smears	396	Number of patients with high-grade dysplasia treated and type of surgical intervention performed	Of the total patients who had been diagnosed with high-grade dysplasia, 21.4% were treated surgically in the pandemic year (15.03.2020–14-03.2021) and 78.6% in non-pandemic period (15.03.2019–14-03.2020). Before COVID-19, excisional biopsies were performed in 31.3% and LEETZ in 47.3% of the total surgical procedures. During the pandemic, excisional biopsy was performed in 6.2% and LEETZ in 15.2% of the total procedures.	5
5	(Ivanuš et al., 2021)	Slovenia	Population-based cervical cancer screening registry (from the National Cervical Cancer Screening Registry – ZORA registry), including women aged 20–64 years	NA	Number of women who underwent invasive procedures 120 days after high-grade screening diagnosis.	Compared to the average of a three-year period (2017–2019), a significantly higher deficit in cold-knife conizations (−91, −39%) compared to LLETZ (−4, −1%) was observed.	7
6	(Koczkodaj et al., 2021)	2021	Population-level data from the National Health Fund		Number of issued oncology diagnosis and treatment cards (ODaTCs) from January to September in the years 2019 and 2020	Absolute number of issued ODaTCs: 651 (2019) vs. 705 (2020).	5
7	(Medenwald et al., 2022)	Germany	Patient-level claims data from fourteen university hospitals	9365 inpatient hospital admissions	Number of radiotherapy fractions (primary outcome) and inpatient hospital admissions (secondary outcome)	The lockdown period (from March 16 to April 28, 2020), radiotherapeutic fractions decreased by 20.0% (1232 to 1539.5, p-value <0.001) in the study cohort compared to the control cohort (2018 and 2019). Megavoltage radiation therapy decreased by 29.5% (660 to 936.5, p-value <0.001), whereas no change was observed for brachytherapy-related fractions (164 to 163, p-value ≥0.05). Within the return-to-normal period (from May 4 to August 2, 2020), the reduction in overall radiotherapeutic fractions was 28.6% (829 to 1160.5, p-value <0.001), whereas megavoltage radiation therapy fractions decreased by 43.7% (411 to 730.5, p-value <0.001) and brachytherapy fractions even increased by 15.0% (123 to 107, p-value ≥0.05;) in 2020 in comparison with the control cohort. Within the lockdown period, overall hospital admissions for cervical cancer fell by 10.2% (352 to 392, p-value >0.05;) in the study cohort compared to the control cohort, whereas a reduction of 22.1% (218 to 280, p-value <0.01) was observed in the return-to-normal period. Radiotherapy admissions without brachytherapy were reduced by 23.9% (167 to 219.5, p-value <0.05), whereas admissions with chemotherapy procedures were reduced by 12.5% (126 to 144, p-value ≥ 0.05), and brachytherapy-related admissions were reduced by 5.0% (85 to 89.5, p-value ≥ 0.05) within the lockdown period in 2020 compared with the control cohort. In contrast, admissions with surgery-related procedures increased non-significantly by 20.5% (100 to 83, p-value ≥ 0.05) in the same period. For the return-to-normal period, radiotherapy admissions without brachytherapy decreased by 44.9% (92 to 167, p-value <0.001;), which was also true for admission with radio- and chemotherapy (37.1%; 66 to 105, p-value <0.01;). In contrast, radiotherapeutic admissions with brachytherapy increased by 14.8% (70 to 61;) and admissions with surgical procedures increased by 7.7% (56 to 52, p-value ≥0.05) in the same period compared with the control cohort.	6
8	(Meggetto et al., 2021)	Canada	Multiple population-based administrative databases	NR	Monthly cervical treatment volumes	The average monthly decrease in cervical treatment volumes was 31.1% or 288 cervical treatments, compared with the same months in 2019.	7

Abbreviations: aNOS, adapted version of the Newcastle-Ottawa Scale checklist for assessing the quality of non-randomized studies; NR, not reported; NA, not applicable; 95% CI 95% confidence interval; CT, chemotherapy; RT, radiotherapy; LEETZ, Large Loop Excision of the Transformation Zone.