Abstract
The recent novel coronavirus, named coronavirus disease 2019 (COVID-19), has developed into an international pandemic affecting millions of individuals with hundreds of thousands of deaths worldwide. The highly infectious nature and widespread prevalence of this disease create a new set of obstacles for the bladder cancer community in both delivering and receiving care. In this manuscript, we address the unique issues regarding treatment prioritization for the patient with bladder cancer and how we at City of Hope have adjusted our clinical practices using a team-based approach that utilizes shared decision making with all stakeholders (physicians, patients, caregivers) to optimize outcomes during this difficult time. In addition to taking standard precautions for minimizing COVID-19 risk of exposure for those entering a healthcare facility (screening all personnel upon entry and donning facemasks at all times), we suggest the following three measures: (1) delay post-treatment surveillance visits until there is a decrease in local COVID-19 cases, (2) continue curative intent treatments for localized bladder cancer with COVID-19 precautions (i.e., choosing gemcitabine/cisplatin (GC) over dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) neoadjuvant chemotherapy), and (3) increase the off-treatment period between cycles of palliative systemic therapy in metastatic urothelial carcinoma patients.
Highlights
A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has developed into an international pandemic affecting millions of individuals in more than 150 countries with hundreds of thousands of deaths worldwide [1,2]
We address the unique issues regarding treatment prioritization for the patient with bladder cancer and how we at City of Hope have adjusted our clinical practices using a team-based, shared decision approach with all stakeholders to optimize outcomes during this difficult time
Patients with Bladder Cancer Undergoing Treatments Are at a Higher Risk for COVID-19 Infections and Worse Outcomes Compared to the General Population without Cancer
Summary
A novel coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has developed into an international pandemic affecting millions of individuals in more than 150 countries with hundreds of thousands of deaths worldwide [1,2]. This disease has been named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) [1] Patients with this disease are at high risk for developing septic shock and hypoxemia, which can frequently progress to acute respiratory distress syndrome (ARDS) and death [3]. This disease creates a new set of obstacles for the bladder cancer community in both delivering and receiving care. Patients with Bladder Cancer Undergoing Treatments Are at a Higher Risk for COVID-19 Infections and Worse Outcomes Compared to the General Population without Cancer. For the patient with bladder cancer undergoing treatment, there are several safety issues that place them at higher risk of infection for COVID-19 compared to the general population without cancer. Sreinpceeatietdiswnaovtesfeoafsiinbfleecttoiondse,lwayhbiclhadsodmereceaxnpceertrsterestaimtmaetents for acnouotldhecro1n8tinmuoenftohrsa, nwoethaetrC1i8tymoofnHthos.pSeinhcaeviet disenvoetlofpeaesdibalecotonsdeenlasyusblfardamdeerwcaonrkcetrotrheealtpmbeanltasnfcoer these cacoonmmotppheeetrtiin1n8ggmrriisosknkstsh(sF(F,igwigueurearte1C)1.i)tB.yyBoyuf Htuilotizipliienzghinatgvheitshdfiersvafmerlaoempweoedrwkao,crwokne,swhenaevsuehsabfvereeanmbeaebewnleoratkobltgeouhtioedlegpuobiuadrleacnolciuneirtchicaelnisnesicians wwiitthhiinn tthhee nneettwwoorrkkoonnhhowowtotommakaekae sahsahreadreddecdiesicoinsiownitwh itthhe tphaetipenattitehnatt tchaant pcrainorpitrizioerbitliazdedbelradder ccaanncceerr ttrreeaattmmeennttssaapppproroppriraitaetleylywwhihleilme miniimniimziinzginthgethrieskrifsokr fCoOr CVIODV-1I9De-1x9poesxuproes(uFrigeu(rFeig1u).re 1)
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