Maximal Cytoreductive Effort in the Time of Pandemic: Outcomes for Patients with Advanced Ovarian Cancer and Lessons for the Future.

Background: The COVID-19 pandemic substantially disrupted healthcare systems worldwide, raising concerns regarding delays in diagnosis, alterations in treatment pathways, and oncological outcomes for women with advanced ovarian cancer (AOC). This study evaluated the impact of the pandemic on the management and survival of patients with AOC treated at a high-volume ESGO-accredited tertiary gynaecological oncology centre. Methods: A retrospective cohort study was conducted using a prospectively maintained database of consecutive women diagnosed with FIGO stage III-IV epithelial ovarian, fallopian tube or primary peritoneal cancer between January 2017 and December 2022. Patients were divided into pre-pandemic and pandemic cohorts. Demographic characteristics, FIGO stage, treatment pathways, surgical outcomes, and overall survival were compared. Survival was analysed using Kaplan-Meier methodology and multivariable Cox proportional hazards regression was performed to evaluate the independent association between the pandemic period and overall survival after adjustment for age, FIGO stage, ECOG performance status and treatment modality. Results: A total of 700 patients were included, 406 patients treated before the pandemic and 294 during the pandemic. Patients diagnosed during the pandemic had a better ECOG performance status, but 51.3% presented with FIGO stage IV disease. Overall treatment rates were maintained (84.4% vs. 87.4% pre-pandemic), although treatment strategies shifted towards increased use of neoadjuvant chemotherapy (55% vs. 42.4%, p < 001), with a greater proportion of patients subsequently undergoing interval debulking surgery. Complete cytoreduction following interval debulking surgery was preserved throughout the study period, despite more advanced disease at presentation. One-year overall survival was similar between cohorts (69% vs. 72.2% pre-pandemic), whereas three-year overall survival was significantly lower among patients treated during the pandemic (36.1% vs. 45.1%). On multivariable Cox regression analysis, treatment during the pandemic remained independently associated with poorer overall survival after adjustment for clinically relevant baseline factors. Conclusions: Despite unprecedented disruption to healthcare services, specialist gynaecological oncology care has maintained access to multimodality treatment and preserved maximal effort cytoreductive surgery. Nevertheless, patients diagnosed during the pandemic experienced inferior long-term survival independent of baseline disease characteristics and treatment allocation, highlighting the broader indirect consequences of the pandemic on cancer outcomes. These findings emphasise the importance of protecting diagnostic pathways, multidisciplinary cancer services and surgical capacity during future healthcare crises.