Urological Cancer Treatment by a Multidisciplinary Team throughout the Covid-19 Pandemic: What Have We Learned?

 

 Permissions and Reprints

Abstract

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center.

Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated.

Results A total of 194 patients were assessed by the multidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. The median age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points).

Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.

Resumen

Introduccion La atención del cáncer se aborda mejor con un equipo multidisciplinario (EMD), aspecto que se tornó más importante en la pandemia por Covid-19, en que las opciones para tratar el cáncer urológico están influenciadas por muchos factores. En algunos casos, el tratamiento retrasado puede tener consecuencias en los resultados oncológicos del paciente. El objetivo de este estudio es describir nuestra experiencia en un centro de referencia y de alto volumen para el tratamiento de neoplasias urológicas durante la pandemia por Covid-19.

Métodos Realizamos un muestreo por conveniencia. Posteriormente, los casos fueron evaluados y discutidos de forma individual en las reuniones del EMD. Posterior a la obtención de un consenso sobre el tratamiento del paciente, los pacientes fueron programados según el riesgo individual de posponer el manejo. Se midió la puntuación de cada paciente en el sistema Medically Necessary Time-Sensitive (MeNTS, “Médicamente necesario, sensibles al tiempo”). Todos los pacientes respondieron el cuestionario de autoevaluación del Centers for Disease Control and Prevention (CDC) COVID-19 antes de la cirugía. Se estimó la tasa de supervivencia libre de Covid-19.

Resultados Un total de 194 pacientes fueron evaluados por el EMD y finalmente tratados, con una mediana de seguimiento de 4 (rango intercuartil [RIC]: 2,75 a 6) meses. Solo dos tenían Covid-19 confirmado por reacción en cadena de la polimerasa en tiempo real (RCP-TR). Un total de 54 pacientes fueron sometidos a cirugía oncológica, 129 fueron tratados con radioterapia, y 11 fueron tratados con quimioterapia intravenosa. La mediana de edad fue de 66 años (RIC: 59 a 94 años), la puntuación mediana en el MeNTS de la cohorte tratada quirúrgicamente fue de 35 puntos (RIC: 31 a 47 puntos).

Conclusiones La evaluación y el tratamiento del cáncer urológico debe ser realizado por un EMD durante la pandemia de Covid-19. Los datos recopilados en nuestra institución mostraron que la mayoría de los pacientes podrían ser tratados de manera segura, discutiendo cada caso individualmente y haciendo un seguimiento cercano.

Ethics Approval and Consent to Participate

The present article was approved by the ethics committee on human research of Pontificia Universidad Javeriana under IRB #2020428–267.

Availability of Data and Materials

The datasets used and/or analyzed during the current study can be made available by the corresponding author upon reasonable request.

Publication History

Received: 17 December 2020

Accepted: 08 March 2021

Article published online:
30 September 2021

© 2021. Sociedad Colombiana de Urología. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Ma X, Ph D, Wang D, Ph D, Xu W, Wu G. et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. 2020: 727-33
  PubMedGoogle Scholar
• 2 Lipsitch M, Phil D, Swerdlow DL, Finelli L. Defining the Epidemiology of Covid-19 — Studies Needed. 2020: 26-8
  PubMedGoogle Scholar
• 3 Emilia R, Academy O, Lieve O, Hospital V, Grande A, Metropolitano O. et al. COVID-19 and Urology: A Comprehensive Review of the Literature. https://doi.org/10.1111/bju.15071
  CrossrefPubMedGoogle Scholar
• 4 Medica EM, Ficarra V, Novara G, Abrate A, Bartoletti R, Crestani A. et al. Urology practice during the COVID-19 pandemic. 2020 DOI: 10.23736/S0393-2249.20.03846-1
  CrossrefPubMedGoogle Scholar
• 5 Simonato A, Giannarini G, Abrate A, Bartoletti R, Crestani A, Nunzio CDE. et al. Clinical pathways for urology patients during the COVID-19 pandemic. 2020 DOI: 10.23736/s0393-2249.20.03861-8
  CrossrefPubMedGoogle Scholar
• 6 Iscaife A, Marchini GS, Srougi V. et al. The urologist's role in the fight of COVID-19 pandemic: mandatory mindset shift on the frontline. Int Braz J Urol 2020; 46 (05) 879-882 DOI: 10.1590/s1677-5538.ibju.2020.0316.
  CrossrefPubMedGoogle Scholar
• 7 Vigneswaran Y, Prachand VN, Posner MC, Matthews JB, Hussain M. What Is the Appropriate Use of Laparoscopy over Open Procedures in the Current COVID-19 Climate?. J Gastrointest Surg 2020; 24 (07) 1686-1691 DOI: 10.1007/s11605-020-04592-9.
  CrossrefPubMedGoogle Scholar
• 8 Prachand VN, Milner R, Angelos P. et al. Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. J Am Coll Surg 2020; 231 (02) 281-288 DOI: 10.1016/j.jamcollsurg.2020.04.011.
  CrossrefPubMedGoogle Scholar
• 9 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 (01) 29-42 DOI: 10.1016/j.eururo.2020.04.063.
  CrossrefPubMedGoogle Scholar
• 10 Sciarra A, Salciccia S, Maggi M. et al. Elective procedures for prostate cancer in the time of Covid-19: a multidisciplinary team experience. Prostate Cancer Prostatic Dis 2020; 19–21: 1-3 DOI: 10.1038/s41391-020-0240-4. [Internet]
  CrossrefPubMedGoogle Scholar
• 11 Negopdiev D. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2020; 107 (11) 1440-1449 DOI: 10.1002/bjs.11746.
  CrossrefPubMedGoogle Scholar
• 12 Assi T, Ibrahim N, Abboud RK, Kattan C, Rassy E, Nemr E. et al. The management of patients with metastatic prostate cancer during the COVID-19 pandemic. 2020 https://doi.org/10.2217/fon-2020-0361
  CrossrefPubMedGoogle Scholar
• 13 Ginsburg KB, Curtis GL, Timar RE, George AK, Cher ML. Delayed Radical Prostatectomy is Not Associated with Adverse Oncologic Outcomes: Implications for Men Experiencing Surgical Delay Due to the COVID-19 Pandemic. J Urol 2020; 204 (04) 720-725 DOI: 10.1097/JU.0000000000001089.
  CrossrefPubMedGoogle Scholar
• 14 Tachibana I, Ferguson EL, Mahenthiran A. et al. Delaying Cancer Cases in Urology during COVID-19: Review of the Literature. J Urol 2020; 204 (05) 926-933 DOI: 10.1097/JU.0000000000001288.
  CrossrefPubMedGoogle Scholar
• 15 Campi R, Amparore D, Capitanio U. et al. Assessing the Burden of Nondeferrable Major Uro-oncologic Surgery to Guide Prioritisation Strategies During the COVID-19 Pandemic: Insights from Three Italian High-volume Referral Centres. Eur Urol 2020; 78 (01) 11-15
  CrossrefPubMedGoogle Scholar