The COVID-19 pandemic's ripple effects: investigating the impact of COVID-19 on endometrial cancer in a large UK regional cancer centre

COVID-19 has had a significant impact on the management of gynaecological malignancies globally. Despite the extensive work investigating the impact of the COVID-19 pandemic on gynaecological cancer care as a whole, little is known with regard to the specific management of endometrial cancer. The aim of this retrospective cohort study was to assess the impact of the COVID-19 pandemic on patients diagnosed with endometrial cancer in Northern Ireland (NI). All patients with endometrial cancer in NI between April 2019-March 2022 were included, divided into three cohorts: pre-COVID, COVID-Year 1 and COVID-Year 2. The median was used to express data that was not normally distributed. Students t-test and Mann-Whitney U test were used to compare means with and without normal distribution respectively. Statistical analysis of count data included the chi-squared test. The p-value < 0.05 was considered statistically significant. 683 patients were included with a similar distribution of age, histology and length of stay. There was a 22% decrease in new endometrial cancer diagnoses in COVID-Year 1 (n = 195) compared to Pre-COVID (n = 249), with evidence of recovery by year 2 (n = 241). In COVID-Year 1 there was a 29% decrease in surgical resections. During COVID-Year 2 there was an increase in symptom duration of > 6 months (21%) compared to Pre-COVID (11% (p = 0.03)). By COVID-Year 2 there was an increase in Stage III disease (19%) compared to Pre-COVID (12% (p = 0.02)). In COVID-Year 1 and 2 there was an increase in the use of adjuvant oncological treatment, with a significant increase in the use of chemoradiotherapy in COVID-Year 2. In conclusion, COVID-19 has significantly impacted the treatment pathways of endometrial cancer patients in NI. There was a significant increase in symptom duration and stage III disease requiring increased use of adjuvant oncological treatments.