Abstract
Simple SummaryThe COVID-19 pandemic has had a major impact on the entire healthcare system, resulting in severe restrictions of nonemergency clinical services, as well as in the clinical practice of uro-oncology. We performed a retrospective analysis to evaluate outcomes of the COVID-19 pandemic resulting from delayed diagnosis, staging, and treatment of bladder cancer. We showed that the COVID-19 pandemic led to a deferred oncological diagnosis and treatment of bladder cancer. More attention is required to avoid adverse outcomes, with increased rates of advanced and aggressive tumors in patients with primary bladder cancer. Moreover, timely treatment is compulsory in those patients.Coronavirus-19 (COVID-19)-induced effects on deferred diagnosis and treatment of bladder cancer (BC) patients are currently not clarified. The aim of this study was to evaluate outcomes of the COVID-19 pandemic by considering its effects on tumor stage and grade, and to create feasible clinical triage decisions. A retrospective single-center analysis of all patients who underwent diagnostic and surgical procedures due to BC, during January 2019 and December 2020, was performed. Due to COVID-19 lockdowns, significantly fewer (diagnostic and therapeutic) endoscopic procedures were performed in the first 6 months of 2020 compared to 2019 (p = 0.002). In patients with a primary diagnosis of BC, a significant increase of high-grade tumors (p < 0.001), as well as advanced tumor stages (p = 0.014), were noticed during 2020 in comparison to 2019. On the contrary, patients with recurrent BC undergoing risk-adapted surveillance, depending on previous tumor histology, showed no adverse outcomes regarding tumor stage and grade when comparing the pre COVID-19 era with 2020. Thus, more awareness in clinical urologic practice is mandatory to avoid adverse consequences, with increased rates of advanced and aggressive tumors in patients with primary BC. In recurrent BC, an individual risk stratification in order to avoid worse outcomes during the COVID-19 pandemic seems to be justified.
Highlights
The coronavirus-19 (COVID-19) pandemic has had a major impact on the entire healthcare system around the world [1]
There was no evidence that cancer patients on chemotherapy or other anticancer treatments are at an increased risk of mortality from COVID-19 compared with cancer patients without active treatment [6]
Recurrent bladder cancer was defined as tumors with a history of non-muscle invasive bladder cancers (NMIBC) undergoing routine surveillance at our institution, according to the European Asscociation of Urology (EAU) guidelines [14]
Summary
The coronavirus-19 (COVID-19) pandemic has had a major impact on the entire healthcare system around the world [1]. In addition to significant psychological burdens and distress in up to 30% of patients linked with a cancer diagnosis, the pandemic has dramatically changed the care of oncologic patients [3]. A recently published study showed that cancer patients who acquired COVID-19 have a higher risk of significantly worse outcomes, including intensive care unit admission or invasive ventilation [4]. The incidence of serious adverse events in asymptomatic COVID-19 positive cancer patients undergoing immunotherapy or chemotherapy was significantly higher compared with COVID-19 negative patients [5]. There was no evidence that cancer patients on chemotherapy or other anticancer treatments are at an increased risk of mortality from COVID-19 compared with cancer patients without active treatment [6]. A higher mortality risk for asymptomatic COVID-19 positive patients is evidenced, following elective surgical interventions [7]
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