Management of germ cell tumors during the outbreak of the novel coronavirus disease-19 pandemic: a survey of international expertise centers

Background: The coronavirus disease 2019 (COVID-19) pandemic has become a public health. emergency, affecting frail populations including cancer patients. This poses the question as to. 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 art management of GCTs during the COVID-19 pandemic a survey including 26 questions was circulated by e-mail among the physicians belonging to 3 cooperative groups: 1. Italian Germ cell cancer Group (IGG); 2. European G3 Domain (Rare male genito-urinary cancers); 3. Genitourinary Medical Oncologists of Canada (GUMOC). Percentages of agreement between I vs C, I vs E and E vs C were compared by using Fisher's exact tests for dichotomous answers and Chi square-test for trends for the questions with 3 or more options. Results: Fifty-three GCT experts responded to the survey: 20 Italian (I), 6 in other European (E) countries and 27 from Canada (C). Telemedicine was broadly utilized; there was high consensus to interrupt chemotherapy in COVID-positive patients (I=75%, C=55% and E=83.3%) and for G-CSF primary prophylaxis use for neutropenia (I=65%, C=62.9% and E=50%). Main differences emerged regarding the management of stage I and stage IIA disease, likely due to cultural and geographical differences. Conclusions: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for GCT patients 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 to minimize frequency and intensity on patient contacts with thinly stretched health care capacity and sharing best practices.