Management of Germ Cell Tumors During the Outbreak of the Novel Coronavirus Disease-19 Pandemic: A Survey of International Expertise Centers

L. Nappi, M. Ottaviano, P. Rescigno, M. Tortora, G.L. Banna, G. Baciarello, U. Basso, C. Canil, A. Cavo, M. Cossu Rocca, P. Czaykowski, U. De Giorgi, X. Garcia del Muro, M. Di Napoli, G. Fornarini, J.A. Gietema, D.Y.C. Heng, S.J. Hotte, C. Kollmannsberger, M. MaruzzoC. Messina, F. Morelli, S. Mulder, C. Nichols, F. Nolè, C. Oing, T. Sava, S. Secondino, G. Simone, D. Soulieres, B. Vincenzi, P.A. Zucali, S. De Placido, G. Palmieri, Italian Germ Cell Cancer Group (IGG), ERN-EURACAN Domain G3, Genitourinary Medical Oncologists of Canada (GUMOC)

Research output: Contribution to journalArticlepeer-review


Background: The coronavirus disease 2019 (COVID-19) pandemic has become a public health emergency affecting frail populations, including patients with cancer. This poses the question of 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-the-art management of GCTs during the COVID-19 pandemic, a survey including 26 questions was circulated by e-mail among the physicians belonging to three cooperative groups: (a) Italian Germ Cell Cancer Group; (b) European Reference Network–Rare Adult Solid Cancers, Domain G3 (rare male genitourinary cancers); and (c) Genitourinary Medical Oncologists of Canada. Percentages of agreement between Italian respondents (I) versus Canadian respondents (C), I versus European respondents (E), and E versus C were compared by using Fisher's exact tests for dichotomous answers and chi square test for trends for the questions with three or more options. Results: Fifty-three GCT experts responded to the survey: 20 Italian, 6 in other European countries, and 27 from Canada. Telemedicine was broadly used; there was high consensus to interrupt chemotherapy in COVID-19–positive patients (I = 75%, C = 55%, and E = 83.3%) and for use of granulocyte colony-stimulating factor primary prophylaxis for neutropenia (I = 65%, C = 62.9%, and E = 50%). The main differences emerged regarding the management of stage I and stage IIA disease, likely because of cultural and geographical differences. Conclusion: Our study highlights the common efforts of GCT experts in Europe and Canada to maintain high standards of treatment for patients with GCT 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 and sharing best practices to minimize frequency and intensity of patient contacts with thinly stretched health care capacity. © 2020 AlphaMed Press
Original languageEnglish
Pages (from-to)e1509-e1515
Issue number10
Publication statusPublished - 2020


  • COVID-19
  • Curable tumors
  • Expert centers
  • Germ cell tumors
  • Pandemic
  • Testicular cancer
  • bleomycin
  • carboplatin
  • cisplatin
  • etoposide
  • granulocyte colony stimulating factor
  • adjuvant chemotherapy
  • Article
  • Canada
  • cancer chemotherapy
  • cancer staging
  • coronavirus disease 2019
  • e-mail
  • Europe
  • germ cell tumor
  • health care personnel
  • health survey
  • human
  • low risk patient
  • lung toxicity
  • neutropenia
  • pandemic
  • physician
  • priority journal
  • questionnaire
  • telemedicine
  • therapy delay
  • throat culture
  • cancer center
  • clinical practice
  • epidemiology
  • neoplasm
  • oncologist
  • prevention and control
  • Cancer Care Facilities
  • Granulocyte Colony-Stimulating Factor
  • Humans
  • Neoplasms, Germ Cell and Embryonal
  • Oncologists
  • Practice Patterns, Physicians'
  • SARS-CoV-2
  • Surveys and Questionnaires
  • Telemedicine


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