Sharyn Lewin, MD, FACS, assistant clinical professor of Obstetrics and Gynecology, Icahn School of Medicine, The Mount Sinai Hospital, gynecologic oncologist and medical director of the Department of Gynecologic Oncology, Holy Name Medical Center, discusses the impact of the coronavirus disease 2019 (COVID-19) on cancer care.

New Jersey is an epicenter of COVID-19, says Lewin. Workers on the frontlines have been battling the virus for the past 6 to 8 weeks. The pandemic had immediate effects on the health care system. In oncology, telehealth became a primary means of physician and patient interaction, particularly for older, asymptomatic patients, says Lewin.

Though providers should weigh the risks and benefits of therapy on a case by case basis, the majority of patients have stopped receiving chemotherapy during the pandemic. In addition to chemotherapy holidays, many surgeries have been postponed. For example, the last surgery Lewin did was in early March. During this time, chemotherapy, radiation, and hormonal therapy have been given up front, says Lewin. In endometrial cancer, that includes the use of levonorgestrel intrauterine devices. The pandemic has underscored the importance of interdisciplinary care, which in many cases, has been guided by national webinars, concludes Lewin.

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Sharyn Lewin, MD, FACS, discusses the impact of the coronavirus disease 2019 (COVID-19) on cancer care.

Dr. Lewin on the Impact of COVID-19 on Cancer Care

Sharyn Lewin, MD, FACS, assistant clinical professor of Obstetrics and Gynecology, Icahn School of Medicine, The Mount Sinai Hospital, gynecologic oncologist and medical director of the Department of Gynecologic Oncology, Holy Name Medical Center, discusses addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery in patients with newly diagnosed advanced-stage ovarian cancer who were receiving neoadjuvant chemotherapy.

In the randomized phase 3 clinical trial published in the 

the role of HIPEC in women who with newly diagnosed disease who had neoadjuvant chemotherapy and then had an interval cytoreduction, says Lewin. The women were randomized to HIPEC at the time of the interval cytoreduction followed by further chemotherapy. Those treated with HIPEC experienced a significantly longer median overall survival than those who did not receive HIPEC, notes Lewin. Specifically, at a median follow-up of 4.7 years, 62% of those who underwent surgery alone versus 50% of those who underwent surgery plus HIPEC died (HR, 0.67; 95% CI, 0.48-0.94; 

 =.02). The median overall survival was 33.9 months in the surgery arm and 45.7 months in the surgery plus HIPEC arm.

The results of the study were impressive, particularly when stratifying out all other variables, notes Lewin. It is an important modality that requires surgical expertise and collaboration with other surgical oncologists, adds Lewin. Given the impressive improvement in survival, it is something that should be offered—especially in the interval setting when women have received neoadjuvant chemotherapy, concludes Lewin.

Sharyn Lewin, MD, FACS, discusses the utility of hyperthermic intraperitoneal chemotherapy in newly diagnosed advanced-stage ovarian cancer.

Sharyn Lewin, MD, FACS

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Dr. Lewin on the Impact of COVID-19 on Cancer Care

Dr. Lewin on the Addition of HIPEC to Interval Cytoreductive Surgery in Ovarian Cancer