Vulvar Cancer Survival Discrepancies Seen in Year 1 of COVID-19 Pandemic

Certain subpopulations experienced significantly poorer outcomes in 2020, highlighting concerns regarding access to care.

Investigators found that survival differences existed among patients diagnosed with vulvar cancer during the first year of the COVID-19 pandemic in 2020 vs the preceding 3 years, according to data from a retrospective cohort study presented at the 2025 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (SGO).

Results from the trial reveal that 3-year overall survival (OS) rates among patients with stage I vulvar cancer were significantly worse in 2020 than the 3 preceding years, with nonsignificant differences observed among other stages. However, after controlling for known confounders such as age, stage, and socioeconomic factors, a 2020 diagnosis was not independently associated with OS in the overall study population.

Moreover, notable survival differences emerged among sociodemographic groups with diagnoses in 2020 compared to the preceding 3 years. Notably, Black patients diagnosed with stage IV vulvar cancer in 2020 experienced a 1-year OS rate of 49.1% compared with 67.9% in 2017 to 2019. Furthermore, the median OS in 2020 was 10.1 months in this patient group vs 25.0 months in 2017 to 2019 (P = .067). By contrast, patients who were not Black saw a less significant decrease in median OS (P = .485) in 2020.

Among uninsured patients, those diagnosed with stage IV vulvar cancer in 2020 saw a significantly elevated risk for death vs a diagnosis in 2017 to 2019 (P = .020). By contrast, insured patients experienced non-significantly worse survival with a diagnosis in 2020 vs 2017 to 2019 (P = .350).

“Survival differences existed amongst patients diagnosed with vulvar cancer during the first year of the COVID-19 pandemic compared to the preceding 3 years, which may be due to exacerbation of known sociodemographic contributors to mortality,” Celena Fussell, MD, resident of Obstetrics and Gynecology at University Hospitals Cleveland Medical Center, wrote in the presentation with coinvestigators. “Various subgroups experienced significantly poorer outcomes in 2020, supporting concerns regarding differential access to care during this time period and highlighting the need for development of public health interventions to address socioeconomic disparities.”

The retrospective cohort study utilized the National Cancer Database to compare outcomes among patients diagnosed with vulvar cancer during the first year of the COVID-19 pandemic vs the 3 prior years. Wilcoxon rank sum and chi square testing were used to compared those diagnosed in 2020 to those diagnosed from 2017 to 2019.Additionally, Kaplan Meier curves were created for 3-year OS and compared via log-rank test for all patients diagnosed with vulvar cancer between 2017 and 2020 and patients stratified by subpopulation.

To identify factors associated with survival, univariate and multivariate cox proportional hazards regression were used. Furthermore, baseline characteristics were compared between those diagnosed in the 3 years preceding the COVID-19 pandemic vs 2020. A higher percentage of patients were diagnosed with stage III or IV disease in 2020 than from 2017 to 2019.

The study sought to explore trends in OS for patients diagnosed with vulvar cancer during the COVID-19 pandemic following a more dramatic increase in mortality observed with vulvar cancer diagnoses, with an average 2.5% annual increase in death rates from 2013 to 2022. This trend persisted despite a 0.6% average increase per year in the rate of vulvar cancer diagnoses from 2012 to 2021.Additionally, the study sought to build upon prior research that observed disparities in health care utilization and outcomes during the COVID-19 pandemic, specifically mortality and morbidity trends reported in different racial and socioeconomic groups.

References

Fussell C, Villarreal E, Reid A, Ferguson L, Armstrong A, Chapman GC. Trends in overall survival for patients diagnosed with vulvar cancer during the COVID-19 pandemic. Presented at the 2025 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (SGO); Seattle, WA, March 14-17, 2025.