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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

  • You have recently undergone surgery for ovarian cancer and are experiencing surgery-related complications
  • You have acute abdominal pain or an intestinal obstruction
  • You have recently been diagnosed with ovarian cancer and are experiencing cancer-related symptoms

Medium priority

Your outpatient appointment may be a medium priority if:

  • You have recently been diagnosed with ovarian cancer but are not experiencing any cancer-related symptoms
  • You have recently undergone surgery for ovarian cancer and are not experiencing any surgery-related complications
  • You are currently receiving chemotherapy. In these cases, some of your appointments may be conducted via telephone
  • You have recently developed new symptoms relating to the treatment you are receiving for ovarian cancer. It may be possible to discuss these new symptoms with your doctor via telephone in order to reduce your number of hospital visits

Low priority

Your outpatient appointment may be a low priority if:

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    You are taking a poly(ADP-ribose) polymerase (PARP) inhibitor as maintenance therapy and have a scheduled follow-up visit. In these cases, any scheduled blood tests and/or imaging appointments may be relocated to your local healthcare centre, with subsequent results discussed between you and your doctor by telephone
  • If you are receiving bevacizumab as maintenance therapy, if there are facilities to continue treatment, supervision and support can be provided via telephone appointments
  • You have a survivorship appointment outside of a clinical trial

Diagnosis and imaging

High priority

Your appointment may be a high priority if:

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    You have an imaging appointment because you have ovarian cancer and are experiencing cancer-related symptoms

Medium priority

Your appointment may be a medium priority if:

  • You have an imaging appointment because your doctor thinks that you might have ovarian cancer

Low priority

Your appointment may be a low priority if:

  • You have an imaging follow-up appointment outside of a clinical trial
  • You are taking a PARP inhibitor as maintenance therapy and have an imaging follow-up appointment

Surgery

High priority

Your appointment may be a high priority if:

  • You have recently been diagnosed with ovarian cancer and require surgery for an intestinal obstruction
  • You have a bowel perforation or peritonitis
  • You have recently undergone surgery and are experiencing problems linked to the surgery such as a perforation or anastomotic leak

Medium priority

Your appointment may be a medium priority if:

  • You require surgery to confirm a diagnosis or ovarian cancer where previous tests suggest this is highly likely
  • You are scheduled to have surgery as your initial treatment to remove/reduce your ovarian cancer
  • You are scheduled to undergo surgery to reduce the size of your ovarian cancer following first-line treatment. In these cases, your full medical history will be reviewed by a multidisciplinary team as it may be possible to delay surgery and continue with your first-line treatment
  • You are scheduled to undergo palliative surgery (e.g. a diverting colostomy or a venting percutaneous endoscopic gastrostomy [PEG] tube)

Low priority

Your appointment may be a medium priority if:

  • You are scheduled to undergo surgery as you are at high risk for developing ovarian cancer
  • You are scheduled to undergo surgery to remove a cyst or mass in your ovary that your doctor thinks is unlikely to be cancer
  • You are scheduled to undergo palliative surgery for recurrent ovarian cancer
  • You are scheduled to undergo surgery to remove a small number of metastatic tumours

Systemic treatment of early disease

High priority

Your appointment may be a high priority if:

  • You are scheduled to receive adjuvant chemotherapy for stage I–IIA, high-grade serous or endometrioid ovarian cancer
  • You are currently receiving treatment as part of a clinical trial

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to receive adjuvant chemotherapy for stage IC–IIA, infiltrative mucinous ovarian cancer

Low priority

Your appointment may be a low priority if:

  • You are scheduled to receive chemotherapy for stage IC–IIA, low-grade, serous, endometrioid, expansile or invasive mucinous ovarian cancer
  • You have stage IC, low-grade, serous, endometrioid, expansile or invasive mucinous ovarian cancer and chemotherapy is a possible treatment option. In these cases, your doctor will advise you of the potential benefits of chemotherapy in light of the risk of COVID-19 infection so that the best approach can be agreed between you and your doctor

Additional considerations for chemotherapy use in early-stage ovarian cancer

  • Preferred chemotherapy regimens for early-stage ovarian cancer include:
    • 3–6 cycles of carboplatin plus paclitaxel (6 cycles in patients with high-grade serous, endometrioid or clear-cell ovarian cancer)
    • 6 cycles of carboplatin
    • The chemotherapy regimen may be adapted if you are older and/or if you have pre-existing comorbidities such as cardiovascular or respiratory disease

Systemic treatment of advanced disease

High priority

Your appointment may be a high priority if:

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    You are scheduled to receive neoadjuvant chemotherapy and are currently experiencing cancer-related symptoms
  • You are scheduled to receive post-operative chemotherapy
  • You are currently receiving post-operative chemotherapy for high-grade, serous or endometrioid ovarian cancer
  • You are due to be tested for the presence of BRCA mutations to see if you might be eligible for treatment with a PARP inhibitor
  • You are receiving treatment as part of a clinical trial

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to receive first-line chemotherapy following surgery for advanced-stage, clear-cell or mucinous ovarian cancer
  • You are scheduled to receive platinum-based chemotherapy for high-grade, serous or endometrioid, recurrent ovarian cancer and are currently experiencing cancer-related symptoms

Low priority

Your appointment may be a low priority if:

  • You are scheduled to receive non-platinum-based chemotherapy for high-grade, serous or endometrioid, recurrent ovarian cancer and are currently experiencing cancer-related symptoms
  • You have slow-growing, recurrent ovarian cancer and are experiencing cancer-related symptoms
  • You are scheduled to receive chemotherapy for a low-grade, serous ovarian cancer

Additional considerations for chemotherapy use in advanced ovarian cancer

  • Platinum-based combination chemotherapy (e.g. carboplatin plus paclitaxel) is preferred and may be given every 3–4 weeks in order to reduce your number of hospital visits and risk of immunosuppression
  • You may receive 4–6 cycles of chemotherapy. However, this may be reduced to 4–5 cycles if you are responding to treatment
  • If you experience paclitaxel-related side effects, this drug may be discontinued early
  • You may receive additional treatments such as prophylactic growth factors to help boost your immune system and make you less vulnerable to serious complications of COVID-19
  • Treatment with steroids may be reduced or stopped as they can suppress your immune system
  • Treatment with bevacizumab may be stopped as it can cause hypertension which could lead to a more severe illness following COVID-19 infection
  • You may receive maintenance therapy with a PARP inhibitor if you have high-grade, serous or endometrioid ovarian cancer, have tested positive for a BRCA mutation and have responded to platinum-based chemotherapy
  • If you have tested positive for a BRCA mutation and are not suitable for platinum-based chemotherapy, you may receive rucaparib (a PARP inhibitor) if you have not received treatment with a PARP inhibitor before
  • Non-platinum-based chemotherapy is considered a low priority and will only be given after careful consideration of the potential benefits in light of the risk of severe illness following COVID-19 infection

Additional considerations for the management of ovarian cancer

  • If you have a confirmed diagnosis of ovarian cancer and are currently participating in a clinical trial, you should contact the clinical trials unit to better understand how the frequency of your treatment and follow-up appointments might be changed

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