Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers
Lucia Nappi, Margaret Ottaviano, Pasquale Rescigno, Marianna Tortora, Giuseppe Luigi Banna, Giulia Baciarello, Umberto Basso, Christina Canil, Alessia Cavo, Maria Cossu Rocca, Piotr Czaykowski, Ugo De Giorgi, Xavier García del Muro, Marilena Di Napoli, Giuseppe Fornarini, Jourik A. Gietema, Daniel Yick Chin Heng, Sebastién J. Hotte, Christian Kollmannsberger, Marco Maruzzo, Carlo Messina, Franco Morelli, Sasja F. Mulder, Craig R. Nichols, Franco Nolè, Christoph Oing, Teodoro Sava, Simona Secondino, Giuseppe Simone, Denis Soulières, Bruno Vincenzi, Paolo Andrea Zucali, Sabino De Placido, Giovannella Palmieri, on behalf of Italian Germ Cell Cancer Group (IGG), ERN-EURACAN Domain G3
Abstract
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of whether cancer treatments can be postponed or modified without compromising their efficacy, especially for highly curable cancers such as germ cell tumors (GCTs). MATERIALS AND METHODS: To depict the state-of-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network-Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. RESULTS: Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19-positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. CONCLUSION: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT with few changes in their management during the COVID-19 pandemic. IMPLICATIONS FOR PRACTICE: Despite the chaos, disruptions, and fears fomented by the COVID-19 illness, oncology care teams in Italy, other European countries, and Canada are delivering the enormous promise of curative management strategies for patients with testicular cancer and other germ cell tumors. At the same time, these teams are applying safe and innovative solutions and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity.