BACKGROUND: The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications. METHODS: A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. FINDINGS: We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients' age was 55 years (range: 18-89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3-12) and 8.1 (range: 3.8-13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients' anxiety. INTERPRETATION: Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients' communication and education.

Center for Shared Decision Making Lillebaelt Hospital University Hospital of Southern Denmark Vejle Denmark

Clinica Universidad de Navarra Madrid Spain

Dance With Cancer Society Ankara Turkey

Department of Gynaecological Oncology Barts Health NHS Trust London UK

Department of Gynaecological Oncology University College Dublin School of Medicine Catherine McAuley Research Centre Mater University Hospital Dublin Ireland

Department of Gynaecology National Institute of Oncology Budapest Hungary

Department of Gynecologic Oncology N N Alexandrov National Cancer Center of Belarus Minsk Belarus

Department of Gynecological Oncology Hollycross Cancer Center Kielce Poland

Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents Pomeranian Medical University Szczecin Poland

Department of Gynecology Imperial College London NHS Trust London London UK

Department of Gynecology with Center for Oncological Surgery Charité University Hospital Berlin Germany

Department of Molecular and Translational Oncology Maria Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Department of Obstetrics and Gynecology Alexandra Hospital University of Athens Athens Greece

Department of Obstetrics and Gynecology Gynecologic Oncology Center 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Oncology Lillebaelt Hospital University Hospital of Southern Denmark Vejle Denmark

Department of Oncology The Finsen Centre Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Regional Health Research Faculty of Health Sciences University of Southern Denmark Odense Denmark

Department of Surgery Institute Gustave Roussy Villejuif France

European Society of Gynaecological Oncoloy Executive Group Prague Czech Republic

Faculty of Medicine Department of Medical Oncology Hacettepe University Ankara Turkey

Faculty of Medicine Department of Obstetrics and Gynecology Division of Gynaecological Oncology Baskent University Ankara Turkey

Faculty of Medicine Department of Obstetrics and Gynecology Division of Gynaecological Oncology Hacettepe University Ankara Turkey

Faculty of Medicine Department of Psychiatry Hacettepe University Ankara Turkey

Fondazione Policlinico Universitario A Gemelli IRCCS Catholic University of the Sacred Heart Rome Italy

Gynecologic Oncology Unit La Paz University Hospital IdiPAZ Madrid Spain

K E F 1 Cancer Society Athens Greece

KIU Patient Organisation for Women with Gynaecological Cancer Copenhagen Denmark

Mallow Flower Foundation Budapest Hungary

Onko Unie Cancer Society Prague Czech Republic

Ovacome Ovarian Cancer Support Charity London UK

Radiotherapy Institute Arnhem The Netherlands

Sant Orsola Malpighi Hospital Bologna Italy

Stress Assesment and Research Center (STAR Hacettepe University Ankara Turkey

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