Ovarian Cancer Remission Rates Remained Stable Before, After COVID-19 Pandemic

Patients with ovarian cancer achieved similar complete and clinical remission rates before and after the COVID-19 pandemic, according to a study published in Cancer Management and Research.1

After the onset of the COVID-19 pandemic in the US, reports emerged of the discontinuation of cancer screening programs, delays in cancer diagnosis and treatment initiation, and altered treatment recommendations aimed at minimizing potential exposure to this immunocompromised population. Ovarian cancer was no exception, as the American College of Surgeons categorized ovarian cancer interval cytoreductive surgery as "semi-urgent" to minimize COVID-19 exposure and reduce surgery-related complications and hospitalizations.2

To accommodate surgery delays and reduce harm in this population, national and international gynecologic oncology societies recommended preferential use of neoadjuvant chemotherapy.1 The pandemic may have also impacted patient outcomes through financial strain, loss of insurance, and barriers to care, such as limited transportation.

Consequently, the researchers assessed the association between the COVID-19 pandemic and cancer remission after initial treatment in patients newly diagnosed with epithelial ovarian cancer to determine whether remission rates remained consistent amid these challenges.

The comparable rates of remission pre- and post-pandemic suggest that COVID-19 did not negatively impact the outcomes of patients with ovarian cancer. | Image Credit: James Thew - stock.adobe.com

Eligible patients were diagnosed with epithelial ovarian cancer between January 1, 2017, and June 30, 2021, at Kaiser Permanente Southern California, which serves a racially, ethnically, and socioeconomically diverse population. They were also required to complete chemotherapy and/or surgery as first-line treatment.

The researchers designated pre- and post-pandemic periods using March 4, 2020, as the cut-off; this was when California implemented the stay-at-home order. Additionally, they collected data on complete and clinical remission outcomes by manual chart reviews. Complete remission was considered no evidence of disease; clinical remission included both complete remission and partial response, defined as an incomplete or partial response to therapy.

Modified Poisson regression was used to evaluate the association between remission and the COVID-19 pandemic. The researchers also assessed effect modification by race and ethnicity.

The study population consisted of 748 patients with ovarian cancer, 72.7% of whom were diagnosed during the pre-pandemic period and 27.3% during the pandemic. The researchers found that patients diagnosed during the pandemic were slightly younger than those diagnosed in the pre-pandemic period (mean age, 60.9 vs 62.6 years; P = .11).

As for race and ethnicity, 46.8% of patients were non-Hispanic White, 33.0% Hispanic, 12.4% Asian/Pacific Islander/other races, and 7.5% non-Hispanic Black patients. In terms of disease stage, as defined by the International Federation of Gynecology and Obstetrics (FIGO), stage III was the most common at diagnosis (39.6%), followed by stage I (27.8%), stage IV (21.5%), and stage II (11.1%). However, no statistically significant differences in race/ethnicity (P = .09) or FIGO stage (P = .65) were observed before or during the pandemic.

After initial therapy completion, 87.2% of patients achieved clinical remission, and 75.1% achieved complete remission. Conversely, 12.8% did not respond to treatment. The researchers determined that the proportion of patients achieving complete remission before and during the pandemic was 75.7% and 73.5%, respectively (P = .53).

The pandemic period was not associated with complete remission in the bivariate (risk ratio [RR], 0.97; 95% CI, 0.88-1.07) or multivariate (adjusted RR, 0.98; 95% CI, 0.90-1.06) models. Similarly, the pandemic period was not associated with clinical remission in either the bivariate (RR, 0.98; 95% CI, 0.92-1.04) or multivariate (adjusted RR, 0.98; 95% CI, 0.92-1.04) models.

However, race and ethnicity modified the association between the pandemic period and complete remission (P < .01). After adjusting for various factors, non-Hispanic White patients were 13% more likely to achieve complete remission during the pandemic than in the pre-pandemic period (RR, 1.13; 95% CI, 1.00-1.28). In contrast, race/ethnicity did not influence the association between the pandemic and clinical remission (P = .90).

The researchers acknowledged their study’s limitations, including that the cohort consisted of insured patients within an integrated health care system. Therefore, their findings may not be generalizable to uninsured patients or those within other types of health care systems. Despite its limitations, the researchers expressed confidence in their study.

“Comparable rates of complete and clinical remission before and after the onset of the pandemic offer some reassurance that outcomes of patients with ovarian cancer were not negatively impacted during the pandemic in our integrated health care system,” the authors concluded.

References

1. Mukherjee A, Ayoub N, Xu L, et al. Clinical remission rates in patients with epithelial ovarian cancer before and after the onset of the COVID 19 pandemic in an integrated healthcare delivery system. Cancer Manag Res. 2025;17:281-291. doi:10.2147/CMAR.S487894
2. Fader AN, Huh WK, Kesterson J, et al. When to operate, hesitate and reintegrate: Society of gynecologic oncology surgical considerations during the COVID-19 pandemic. Gynecol Oncol. 2020;158(2):236-243. doi:10.1016/j.ygyno.2020.06.001