Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers

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.

Keywords: COVID-19; Curable tumors; Expert centers; Germ cell tumors; Pandemic; Testicular cancer.

Figure 1

Epidemiology of COVID‐19. Epidemic graphic maps of Europe (A), Italy (B), and Canada (C) at the time the survey was circulated among the European Reference Network–Rare Adult Solid Cancers Domain G3, Italian Germ Cell Cancer Group, and Genitourinary Medical Oncologists of Canada. The maps report the prevalence of the patients positive for COVID‐19 corresponding to the last day of the survey. The tables report the survey dates and the prevalence of COVID‐19–positive patients and COVID‐19–related deaths at the time of the survey. The red dots mark the geographic areas of the respondent physicians. Abbreviation: COVID‐19, coronavirus disease 2019.

Figure 2

Testicular germ cell tumors management during COVID‐19 pandemic. Summary plots report the percentage of Italian (blue), Canadian (red), and European (green) responses to the GCT patient management survey during the COVID‐19 pandemic. Abbreviations: BEP, bleomycin, etoposide, and platinum; COVID‐19, coronavirus disease 2019; CSI, clinical stage I; G‐CSF, granulocyte colony‐stimulating factor; GCT, germ cell tumor; HDCT, high‐dose chemotherapy; LVI, lymphovascular invasion; RT, radiotherapy; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; TM, tumor markers.