The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future

Abstract

Context The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward. Objective To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic. Evidence acquisition A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families. Evidence synthesis Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients’ mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement. Conclusions The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care. Patient summary The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

COVID-19 restrictions on multidisciplinary team meeting decision-making: service evaluation in a major UK cancer centre

“…Further improvements and innovations are, however, needed throughout the NHS and other healthcare systems to mitigate some of the current deficits. The changes to healthcare provision owing to COVID-19 can also be seen as an opportunity to improve patient care and efficiency while maintaining high quality of care 3 , 4 .…”

Impact of the COVID-19 pandemic on oncological and functional robotic-assisted surgical procedures

“…Because of the lockdown, many patients could have neglected their symptoms or failed to consult a physician due to fear, resulting in advanced disease at diagnosis with less treatment options [ 17 ]. Although some cancer treatments can be delayed for a few weeks with a low risk of progression, it is not recommended for more aggressive cancers as it can impact outcome and survival [ 18 – 20 ]. Moreover, holding off initial therapy could result in the progression of the disease with a more aggressive surgery needed and a higher morbidity.…”

Incidence of Missed Diagnosed COVID-19 Pneumonia on Patients Who Admitted Urology Outpatient Clinic

“…They are playing an important role in the fight against COVID-19 during this pandemic. They also must be aware of the potential signs of illness (28). Based on these findings, we evaluated the lung base findings of the patients' abdominal CT. We found that a significant part of the patients has typical findings of COVID-19 pneumonia.…”