To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes. Materials and methods: A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay. Results: The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed. Conclusion: The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic.
Coronavirus disease–2019 (COVID-19), a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages throughout the world. There is a high incidence of infection and mortality among cancer patients with evidence to support that patients diagnosed with cancer and SARS-CoV-2 have an increased likelihood of a poor outcome. Clinically relevant changes imposed as a result of the pandemic, are either primary, due to changes in timing or therapeutic modality; or secondary, due to altered cooperative effects on disease progression or therapeutic outcomes. However, studies on the clinical management of patients with genitourinary cancers during the COVID-19 pandemic are limited and do little to differentiate primary or secondary impacts of COVID-19. Here, we provide a review of the epidemiology and biological consequences of SARS-CoV-2 infection in GU cancer patients as well as the impact of COVID-19 on the diagnosis and management of these patients, and the use and development of novel and innovative diagnostic tests, therapies, and technology. This article also discusses the biomedical advances to control the virus and evolving challenges in the management of prostate, bladder, kidney, testicular, and penile cancers at all stages of the patient journey during the first year of the COVID-19 pandemic.
Purpose: Daily aspirin use following cardiovascular intervention is commonplace and creates concern regarding bleeding risk in patients undergoing surgery. Despite its cardio-protective role, aspirin is often discontinued 5e7 days prior to major surgery due to bleeding concerns. Single institution studies have investigated perioperative outcomes of aspirin use in robotic partial nephrectomy (RPN). We sought to evaluate the outcomes of perioperative aspirin (pASA) use during RPN in a multicenter setting. Materials and Methods: We performed a retrospective evaluation of patients undergoing RPN at 5 high volume RPN institutions. We compared perioperative outcomes of patients taking pASA (81 mg) to those not on aspirin. We analyzed the association between pASA use and perioperative transfusion. Results: Of 1,565 patients undergoing RPN, 228 (14.5%) patients continued pASA and were older (62.8 vs 56.8 years, p <0.001) with higher Charlson scores (mean 3 vs 2, p <0.001). pASA was associated with increased perioperative blood transfusions (11% vs 4%, p <0.001) and major complications (10% vs 3%, p <0.001). On multivariable analysis, pASA was associated with increased transfusion risk (OR 1.94, 1.10e3.45, 95% CI). Conclusions: In experienced hands, perioperative aspirin 81 mg use during RPN is reasonable and safe; however, there is a higher risk of blood transfusions and major complications. Future studies are needed to clarify the role of antiplatelet therapy in RPN patients requiring pASA for primary or secondary prevention of cardiovascular events.
Background: Although patient outcomes for esophageal cancer have improved, there remains a reduced survivorship among African Americans compared to Caucasians, possibly due to lower use of surgery in African Americans. While various factors contribute to this disparity, we noted a decreased referral of African American patients to thoracic surgeons in our institution. We hypothesized that interviews with medical providers would provide the reasons behind the barriers that hinder the ability of minority patients to receive optimal care for esophageal cancer. Methods: Providers (n=20) in the Detroit Metro area that treat African Americans with esophageal cancer participated in 30-minute semi-structured interviews to elicit their perspectives regarding barriers and facilitators in their care for this population. The interview inquired into the challenges faced and techniques employed by providers in establishing trust within this population. Interviewed providers included thoracic surgeons, medical oncologists, gastroenterologists, and radiation oncologists. Results: Most providers suggested that socioeconomic status, not race, was the primary barrier to accessing adequate cancer care. Within the African American population, 80% of providers reported that mistrust was not an issue in their personal experiences in treating minorities with esophageal cancer, but 95% of providers cited mistrust in the medical system as a contributing factor to unfavorable outcomes. Providers who indicated mistrust in the medical system referred to historical instances that may deter African American patients from trusting the medical system. Many also cited techniques for establishing trust including honesty and patient empowerment. Finally, 3 of 20 respondents referred to direct experiences where patient refusal to participate in clinical trials may have contributed to poorer outcomes. Conclusions: Medical providers believe that mistrust in the medical system is a key barrier for African American patients with esophageal cancer to receive optimal care. Further investigation to elicit patient perspectives should be explored through direct patient surveys. Particular attention should be directed toward how African Americans' trust of the medical community affects the use of surgical treatment for esophageal cancer. Citation Format: Sumaiya Sarwar, Michael T. Kemp, Sha'Shonda L. Revels, Benjamin M. Eilender, Steven R. Houtschilt, Clifford Akateh, Rishindra M. Reddy. Medical providers perceive a lack of trust in the medical system leads to suboptimal esophageal cancer care for African American patients. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4684. doi:10.1158/1538-7445.AM2014-4684
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