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June 2, 2020: The Impact of COVID-19 on the Practice of Gynecologic Oncology

The COVID-19 pandemic has affected the practice of medicine throughout the world, challenging health care workers physically, emotionally, academically, and financially. The Society of Gynecologic Oncology’s (SGO) Clinical Practice Committee and COVID-19 Task Force sought to better understand the impact of the pandemic on women’s healthcare providers, patients and the subspecialty. In April, a survey focusing on the effects of COVID-19 was sent to all SGO members. This Communique presents the collected data below.

Demographics
Following distribution of the survey, 227 of our members replied (10% response rate). Almost all the respondents were gynecologic oncologists (94%). Though there were responses from 15 different countries and 40 different states, the bulk of the responses were from New York (13%), California (9%), Pennsylvania (7%) Illinois (5%), and Texas (6%). The most common type of practice setting was a university or medical school (52%).

Impact on Productivity and Cancer Care Delivery
There were significant negative impacts on both surgical and clinical productivity among respondents, with 83% experiencing a 50% or greater reduction in surgical volume, with only 3% maintaining 90% of their standard OR volume. Similarly, almost 83% suffered more than a 50% decline in outpatient clinical volume. In preparation for catching up on these cases:

  • 51% created waiting lists and 25% booked cases 6-12 weeks in the future.

Telehealth

  • Telehealth was used for a significant number of visits (over 50% are completing >75% of visits via telehealth and 80% are using it 100% of the time) even though 33% did not receive formal telehealth training. Eighty percent were using telehealth prior to chemotherapy infusion visits to minimize point of contact.
  • Interestingly, 78% reported that they will continue to utilize telehealth to care for some patients, especially for post-operative visits (42%), second opinions (47%), and surveillance visits (37%).

Most (84%) respondents had to change office and surgical schedules as well as call coverage. Given the dramatic impact on clinical practice during the pandemic, the majority (51%) will change their approach to triaging new patients, scheduling chemotherapy visits, prioritizing surgical scheduling, or providing surveillance visits.

Impact on Practitioners

  • 30% suffered a reduction in either their salary or the salaries within their division.
  • 81% of those who responded were slightly (23%), somewhat (30%), or very (28%) concerned about the negative impact on RVU’s and financial compensation.
  • Only a small percentage (7%) were redeployed to other areas of the hospital outside the scope of their typical practice.

Changes in the Management of Newly Diagnosed Cancers

  • 72% began utilizing more neoadjuvant chemotherapy, 58% of whom used it either greater than 50% or 100% of the time. A combination of trying to avoid prolonged hospitalization, minimize blood loss, and prevent potential ICU admissions (65%) were cited as the main reasons for this increase.
  • Only 20% did not delay interval cytoreduction beyond 3-4 cycles, with most individualizing the timing of surgery on a case by case basis.
  • Interestingly, 81% of respondents continued treating patients with maintenance chemotherapy
  • 36% began utilizing prophylactic growth factors more liberally or on all patients.
  • Clinical trials were dramatically affected by the pandemic with 61% stating that they stopped enrolling patients.

Impact on Physician Wellness
Fortunately, 97% of respondents were not infected with COVID-19, while 9% report having a family member who had been infected or who had succumbed to the virus. However, the emotional toll on members has been high.

  • 93% were either somewhat or greatly concerned about becoming infected at work and bringing it home to their family.
  • Only 25% felt like they did not have to compromise their well-being during the pandemic.
  • Thankfully, despite the fears associated with contracting the virus, the majority (80%) have not considered temporarily quitting or retiring from medicine.

Summary
The impact of the COVID-19 pandemic is ongoing with far-reaching practice implications for years to come. The reported data provides a small snapshot of how the virus has impacted the Society with the initial surge; members can utilize this information to understand and tailor best practices in care if another surge or future pandemic occurs.

Disclaimer: SGO COVID-19 Communiqués are produced by the SGO COVID-19 Task Force and dispatched in a rapidly evolving environment with enormous variation depending on time and location. They are not to be construed as hard and fast practice guidelines, but temporary considerations during the COVID-19 emergency crisis. For more information:

SGO’s COVID-19 Resources are generously supported by an independent medical education grant from AstraZeneca.

SGO thanks the following sponsors for support of our COVID-19 resources: