Effect of Covid-19 pandemic on the progression of bladder cancer patients

Year 2021, Volume: 46 Issue: 2, 627 - 631, 30.06.2021

Ediz Vuruşkan Kadir Karkin Hakan Erçil

https://doi.org/10.17826/cumj.869815

Abstract

Purpose: The aim of this study was to discuss the progression results of patients with muscle invasive bladder cancer (MIBC) who delayed their treatment by not making hospital visits on time for fear of contamination during the COVID-19 pandemic.
Materials and Methods: Records of patients diagnosed with MIBC and recommended radical cystectomy (RC) between March 2020 and June 2020 were reviewed. Whether patients were operated on the scheduled time, and if not, the time elapsed after the first diagnosis or the end of neoadjuvant chemotherapy (NAC) were recorded. The patients who applied to our clinic late were restaged and examined whether there was any progression during the pandemic period.
Results: NAC was recommended before RC in 9 of 24 patients, RC was recommended directly to the remaining 15 patients. After NAC, RC was applied to four patients in the planned period, and 4 patients applied delayed. The mean admission period of the patients who applied late after NAC was 197.8±68.5 days. Lung metastases and pelvic lymphadenopathies were found in two (50%). RC was applied to eight of fifteen patients who did not receive NAC in the planned period. Five of these patients applied for RC in the late period and the average application time after diagnosis was 202.8±31.9 days. In the staging of these five patients who presented late, two (40%) had progression (cT2, N0,M1b).
Conclusion: In times of widespread COVID-19 outbreak, physicians should be alert to potential stage progression and worse survival outcomes resulting from delays in diagnosis and treatment.

Keywords

COVID-19, Coronavirus, Bladder cancer, Delayed treatment, Progression

Mesane kanserli hastaların progresyonuna Covid-19 pandemisinin etkisi

Abstract

Amaç: Çalışmamızda COVID-19 pandemisi sırasında kontaminasyon korkusuyla hastane ziyaretlerini zamanında yapmayarak, tedavilerini geciktiren kasa invaze mesane kanserli (MIBC) hastaların progresyon sonuçlarını tartışılması amaçlanmıştır.
Gereç ve Yöntem: Mart 2020 ile Haziran 2020 tarihleri arasında MIBC tanısı alan ve radikal sistektomi (RC) önerdiğimiz hastaların kayıtları incelendi. Hastaların planlanan zamanda opere edilip edilmediği, edilmediyse ilk tanı anı veya neoadjuvan kemoterapi (NAC) bitiminden sonra geçen süre kaydedildi. Kliniğimize geç başvuran hastalara yeniden evreleme yapılarak pandemi sürecinde progresyon gelişip gelişmediği incelendi.
Bulgular: Yirmidört hastanın dokuzuna RC öncesi NAC önerilirken, kalan 15 hastaya direkt olarak RC önerildi. NAC sonrasında, dört hastaya planlanan sürede RC uygulandı, 4 hasta ise gecikmiş olarak başvuru yaptı. Geç başvuru yapan hastaların NAC sonrası ortalama başvuru süresi 197.8±68.5 gündü. İkisinde (%50) akciğer metastazı ve pelvik lenfadenopatiler bulundu. NAC almayan onbeş hastanın sekizine planlanan sürede RC uygulandı. Bu hastalardan beşi RC yapılmak üzere geç dönemde başvuru yaptı ve tanı konulduktan sonraki ortalama başvuru süresi 202.8±31.9 gündü. Bu beş hastanın ikisinde (%40) progresyon (cT2, N0, M1b) olduğu tespit edildi.
Sonuç: COVID-19 salgının yaygın olduğu dönemlerde hekimler tanı ve tedavideki gecikmelerden kaynaklanan potansiyel evre progresyonu ve daha kötü sağkalım sonuçları açısından dikkatli olmalıdır.

Keywords

COVID-19, Mesane kanseri, Gecikmiş tedavi, Koronavirus, Progresyon

References

• 1. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
• 2. Wallis CJD, Novara G, Marandino L, et al. Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic. Eur Urol. 2020;78(1):29-42.
• 3. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-46.
• 4. Crispo A, Montagnese C, Perri F, et al. COVID-19 Emergency and Post-Emergency in Italian Cancer Patients: How Can Patients Be Assisted? Front Oncol. 2020;10:1571.
• 5. Paner GP, Stadler WM, Hansel DE, Montironi R, Lin DW, Amin MB. Updates in the Eighth Edition of the Tumor-Node-Metastasis Staging Classification for Urologic Cancers. Eur Urol. 2018;73(4):560-9.
• 6. Tachibana I, Ferguson EL, Mahenthiran A, et al. Delaying Cancer Cases in Urology during COVID-19: Review of the Literature. J Urol. 2020;204(5):926-33.
• 7. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020;396(10243):27-38.
• 8. Mian BM, Siddiqui S, Ahmad AE. Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes. Urol Oncol. 2020. Online ahead of print.
• 9. Russell B, Liedberg F, Khan MS, et al. A Systematic Review and Meta-analysis of Delay in Radical Cystectomy and the Effect on Survival in Bladder Cancer Patients. Eur Urol Oncol. 2020;3(2):239-49.
• 10. Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS. Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results-Medicare analysis. Cancer. 2009;115(5):988-96.
• 11. Maganty A, Yu M, Anyaeche VI, et al. Referral pattern for urologic malignancies before and during the COVID-19 pandemic. Urol Oncol. 2020. Online ahead of print.
• 12. Wallace DM, Bryan RT, Dunn JA, Begum G, Bathers S. Delay and survival in bladder cancer. BJU Int. 2002;89(9):868-78.
• 13. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34.
• 14. Boeri L, Soligo M, Frank I, et al. Delaying Radical Cystectomy After Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer is Associated with Adverse Survival Outcomes. Eur Urol Oncol. 2019;2(4):390-6.