Abstract
Objectives: To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID‐19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer‐reviewed literature regarding the safety of delayed treatment. Methods: We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID‐19 related constraints on non‐urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence‐based recommendations. Results: Due to the rapidly changing information about epidemiology and infectious characteristics of COVID‐19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real‐time updates on the changing landscape of the restrictions being placed on non‐urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2‐6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence‐based recommendations for safely postponing cancer care for certain types of urologic cancers. Conclusion: The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real‐time. These real‐time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.
Highlights
Since the initial reports in late December 2019 of respiratory illness caused by a novel coronavirus (COVID-19) originating in Wuhan, China, the disease has made its way to over 200 countries.[1]
As of April 20, 2020, over 2 400 000 COVID-19 cases had been reported globally, resulting in over 165 000 deaths.[4]. With such an exponential increase in COVID-19 infections, many counties were caught unprepared for the massive demand on their healthcare system, including parts of China, Europe, and the USA
Our inability to perform wide scale testing to identify asymptomatic cases and perform appropriate contact tracing further accelerated the spread of COVID-19
Summary
Since the initial reports in late December 2019 of respiratory illness caused by a novel coronavirus (COVID-19) originating in Wuhan, China, the disease has made its way to over 200 countries.[1]. Muscle-invasive bladder cancer (MIBC) is an aggressive disease that carries high risk for metastatic progression, including a relatively high incidence of relapse even after radical cystectomy.[63] Given the association with occult metastases at time of diagnosis, the accepted standard of care currently involves administration of platinum-based NAC based on evidence of 5% overall survival benefit and 9% disease-free survival benefit, especially if initiated within 2 months of diagnosis.[64,65]. Due to the low incidence of this disease, the data on the safety of decayed RPLND is scant but delays in surgical care, exceeding 3 months, have been shown to significantly compromise survival.[86] Due to the favorable demographics of this cohort (young, healthy), absence of alternative therapies at this stage, and the curative nature of these interventions, RPLND for residual mass should be prioritized. Intermediate-risk High-risk Very high-risk Kidney cancer Small renal mass (≤4 cm)
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