Impact of COVID-19 on oncological outcomes during follow-up in gynaecological cancer: A nationwide retrospective cohort study

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic, hospital-based follow-up care after gynaecological cancer was suddenly upended in order to reduce virus transmission, impacting the frequency and delivery of outpatient follow-up consultations in gynaecologic follow-up care. The objective of this study is to investigate the impact of the changes in follow-up care delivery on oncological outcomes in gynaecologic cancer survivors. METHODS: This nationwide population-based retrospective cohort study used data from the Netherlands Cancer Registry (NCR) and the Nationwide Network of Histopathology and Cytopathology (PALGA). Patients treated for epithelial ovarian, cervical, high stage endometrial or vulvar cancer, who either received the first two years of follow-up care pre-pandemic (2017-2019) or during the COVID-19 pandemic (2020-2021), were included. Two-year recurrence-free survival (RFS) and two-year overall survival (OS) were calculated, and analyses were adjusted for confounding. RESULTS: A total of 9062 patients were included, of whom 48.6 % (n = 4408) received follow-up pre-pandemic and 51.4 % (n = 4654) during COVID-19. RFS was comparable between pre-pandemic and COVID-19 cohorts in ovarian (hazard ratio [HR] 1.10, 95 % confidence interval [CI] 0.94-1.28), cervical (HR 1.07, 95 % CI 0.81-1.40), endometrial (HR 1.19, 95 % CI 0.93-1.53) and vulvar cancer (HR 1.01, 95 % CI 0.77-1.31). Moreover, there were no significant differences in OS, also after multivariable adjustments. CONCLUSION: This study demonstrates that two-year RFS and two-year OS during follow-up after treatment for a gynaecologic malignancy were not impacted by the follow-up care, as provided during the COVID-19 pandemic. These findings indicate that adaptations in follow-up care during the COVID-19 pandemic were not associated with worse oncological outcomes, warranting further investigation into more flexible follow-up strategies.