Impact of the COVID-19 pandemic on diagnosis, treatment, and prognosis of cervical, endometrial, and ovarian cancers

The coronavirus disease 2019 pandemic disrupted healthcare systems worldwide, but population-based evidence on its effects on gynecologic cancer care remains limited. We evaluated changes in diagnosis, disease presentation, treatment timeliness, and cancer-specific survival (CSS) for cervical, endometrial, and ovarian cancers during the pandemic. In this retrospective cohort study, Surveillance, Epidemiology, and End Results (SEER)-22 data were used to evaluate trends in newly diagnosed cases from 2017 to 2021, and SEER-17 data to compare patients diagnosed in 2020 (pandemic cohort) with those diagnosed in 2018 to 2019 (pre-pandemic cohort). Eligible patients were aged 20 to 85 years with primary cervical, endometrial, or ovarian cancer. Demographic characteristics, disease presentation, time from diagnosis to treatment initiation, and CSS were compared using ordinal logistic regression, logistic regression, and Kaplan-Meier/log-rank analyses. The cohorts comprised 7997 patients with cervical, 36,151 with endometrial, and 11,508 with ovarian cancer; median follow-up in the pandemic cohort was 27 to 28 months. In SEER-22, new diagnoses in 2020 decreased by 8.7%, 5.5%, and 6.5% for cervical, endometrial, and ovarian cancers versus 2019. Diagnosis in 2020 was associated with more advanced-stage endometrial cancer (odds ratio, 1.06; 95% confidence interval [CI], 1.01-1.12; P = .027) but not cervical or ovarian cancer. Median time from diagnosis to treatment was shorter in the pandemic cohort for cervical (28 vs 30 days; P = .019) and endometrial cancer (28 vs 31 days; P < .001), but not for ovarian cancer (6 vs 4 days; P = .127). The pandemic cohort had borderline worse CSS for cervical cancer (hazard ratio [HR], 1.11; 95% CI, 1.00-1.24; P = .050) and worse CSS for endometrial cancer (HR, 1.10; 95% CI, 1.02-1.18; P = .009), but not ovarian cancer (HR, 1.05; 95% CI, 0.98-1.14; P = .185); 18-month CSS rates (pre-pandemic vs pandemic) were 86.6% vs 84.5%, 93.1% vs 92.6%, and 82.8% vs 83.0%. The pandemic period was associated with fewer recorded diagnoses of the 3 major gynecologic cancers, a modest shift toward more advanced-stage endometrial cancer, and worse short-term CSS for cervical and endometrial cancers. The reduction in recorded diagnoses may reflect disrupted screening and delayed presentation rather than a true decline in cancer occurrence.