ABSTRACT
Introduction & Objectives: During the first wave of COVID-19 patients’ anxieties around contracting the virus during an emergency hospital admission were high. As further COVID-19 surges are possible it is important for healthcare service providers to inform patients of the risk of catching COVID-19 after an emergency hospital admission. Our aim was to establish the risk of catching COVID-19 as a urology emergency inpatient in our Trust and to assess patients fears and attitudes towards seeking medical help for their acute urological problems. Materials & Methods: A single centre study was conducted. A retrospective audit of all urological emergency admissions was made over a 10-week period (mid- March – end of May) in 2019 and compared to (mid-March – end of May) 2020 during the COVID-19 pandemic. The number of patients who developed new COVID-19 symptoms whilst an in-patient or had positive swabs within 28 days of discharge was obtained. We performed a post discharge telephone survey of patients based on a COVID-19 fear questionnaire (FC19-HVQ) adapted from the validated Fear of COVID-19 scale. Results: Compared to 2019 (n=187), 2020 (n=122) there was a 35% reduction in the number of patients presenting acutely to our department. 43 of the 122 (35%) patients were swabbed on admission due to possible symptoms of COVID-19. One patient was found to be COVID-19 positive. 5 patients had further swabs during their admission;one patient who was negative on admission became positive whilst an inpatient. Accordingly, the overall in-hospital infection rate with COVID-19 was 0.82% (1 patient) during or within 28 days of discharge. There was no mortality (0%) related to COVID -19. The majority of patients were afraid to visit A&E or be admitted to hospital during the COVID-19 pandemic crisis. Fewer patients were afraid to visit their local Family Doctor (GP). 28% (n=14) of responders ignored their symptoms during the pandemic. Patients were reluctant to seek medical input during COVID-19 with up 64% (n=32) of them stating that they attempted treat themselves at home. There was also a degree of intentional delay to visit A&E and the hospital with 56% (n=28) of our patients admitting to having delayed their visit. Conclusions: The risk of contracting COVID-19 whilst a urology in patient in a COVID-19 epicentre was very low (0.82%) with no COVID-19 related mortality. Our data supports the message that patients with urological emergencies should be educated and encouraged to attend hospital, rather than staying at home, during future surges in the current pandemic. This is to prevent further non COVID-19 related harm from delayed presentations, undiagnosed pathologies and self-treatment approaches.
ABSTRACT
Introduction & Objective: During the first wave of COVID-19 we saw a reduction in urgent urological admissions. Concurrently, we had to adapt and change our standard management of urological emergency admissions. We wished to evaluate the impact of COVID-19 on urological emergencies in a UK COVID-19 epicentre. Methods: Retrospective audit of all urological emergencies over a 10-week period (mid-March - end of May) in 2019 was compared to the same period during COVID-19. Results: From 2019 to 2020 we saw a reduction of 35% (187 [2019] and 122 [2020]) in urological emergency admissions. The average inpatient stay was 1.76 days (range 0-24 days) in 2020 from 2.65 days (range 0-38 days) in 2019. The largest reduction in presentation was seen in renal colic 43% (58 [2019] and 33 [2020]) followed by visible haematuria 39% (37 [2019] and 23 [2020]). There was a decrease in surgical management of urological emergencies during COVID-19. Scrotal exploration for testicular pain went from 57% (21 of 37) 2019 to 39% (12 of 31) during COVID-19. Stenting for colic and confirmed ureteric stones decreased from (20 of 25) 80% in 2019 to 11% (2 of 18) in 2020. “Hot” ESWL rates for ureteric stones increased from no patients [2019] to 61% (11 of 18) in 2020. In 2019, 12% (6 of 49) of emergency procedures were performed by Consultants however this increased to 48% (11 of 23) in 2020 due to redeployment of urological registrars. The overall in-hospital COVID-19 infection rate was only 0.82% during or within 28 days of discharge with no COVID-19 related mortality (0%). Conclusions: Inpatient infection rate from COVID-19 was very low and there was no related mortality therefore patients should not fear hospital attendance or admission. Longer term follow-up of patients managed conservatively rather than surgically is necessary to ensure no long-term harm has been caused by a change in standard surgical management of urological emergencies. (Table Presented).
ABSTRACT
Introduction & Objective: During the first wave of COVID-19 patients' anxieties around contracting the virus during an emergency hospital admission were high. Our aim was to establish the risk of catching COVID-19 as a urology emergency inpatient in our Trust and to assess patients fears and attitudes towards seeking medical help for their acute urological problems. Methods: A single centre retrospective audit of all urological emergency admissions was made over a 10-week period (mid- March - end of May) in 2019 and compared to (mid-March - end of May) 2020 during the COVID-19 pandemic. The number of patients who developed new COVID-19 symptoms whilst an inpatient or had positive swabs within 28 days of discharge was obtained. We performed a post discharge telephone survey of patients based on a COVID-19 fear questionnaire (FC19-HVQ) adapted from the validated Fear of COVID-19 scale. Results: Compared to 2019 (n = 187), 2020 (n = 122) there was a 35% reduction in the number of patients presenting acutely to our department. 43 of the 122 (35%) patients were swabbed on admission due to possible symptoms of COVID-19. One patient was found to be COVID-19 positive. 5 patients had further swabs during their admission;one patient who was negative on admission became positive whilst an inpatient. Accordingly, the overall in-hospital infection rate with COVID-19 was 0.82% (1 patient) during or within 28 days of discharge. There was no mortality (0%) related to COVID -19. The majority of patients were afraid to visit A&E or the hospital during the COVID-19 pandemic crisis. Fewer patients were afraid to visit their local Family Doctor (GP). 28% (n = 14) of responders ignored their symptoms during the pandemic. Patients were reluctant to seek medical input during COVID-19 by trying to treat themselves at home with 64% (n = 32) of them stating that they attempted to do so. There was also a degree of intentional delay to visit A&E and the hospital with 56% (n = 28) of our patients admitting to having delayed their attendance. Conclusions: The risk of contracting COVID 19 whilst a urology in patient in a COVID- 19 epicentre was very low (0.82%) with no COVID-19 related mortality. Our data supports the message that patients with urological emergencies should be educated and encouraged to attend hospital, rather than staying at home, during future surges in the current pandemic. This is to prevent further non COVID-19 related harm from delayed presentations, undiagnosed pathologies and self- treatment approaches.
ABSTRACT
Background: The COVID-19 pandemic caused disruptions in cancer care delivery and forced oncologists to make recommendations about safely delaying initiation of cancer therapy. Compared to the adjuvant, curative setting, there is a scarcity of information about the impact of time to treatment initiation on outcomes in the palliative setting for gastrointestinal malignancies. We sought to determine the median time to initiation of systemic therapy (TIT) in mPC in the US prepandemic, and to assess the impact of TIT on survival outcomes. Methods: We retrospectively analyzed de-identified data of patients with mPC in the Flatiron Health nationwide EHRderived database. Metastatic diagnosis dates between 01/2014 and 04/2020 were included. Demographics, treatments, and outcomes were collected. TIT was defined as period between diagnosis and initiation of first-line systemic therapy and was split into 3 categories (I: < 2 weeks, II: 2- <4 weeks, and III: 4-8 weeks). Overall survival (OS) was defined from time of diagnosis to time of death. Post-chemotherapy survival (PCS) was time from initiation of firstline therapy to death. Adjusted and unadjusted multinomial logistic regression were used to evaluate the association of demographics and clinical factors with TIT. PCS and OS were estimated with Kaplan-Meier curves. Adjusted (demographics and clinical factors) Cox proportional hazard models were used to estimate the effect of TIT groups on PCS and OS. Category II served as control group. Results: 3231 patients with mPC who received at least one line of treatment were identified. 29% (N= 947), 43% (N=1375), and 28% (N= 909) were in TIT categories I-III respectively. The mean age at diagnosis was 67.4 years, with no significant difference in age (P=0.14) among categories. Median TIT was 20 days. Multinomial logistic regression showed that compared to TIT II, Black patients were less likely than White patients to receive chemotherapy in less than 2 weeks (P=0.02), and those who had recurrent disease were more likely to receive therapy in less than 2 weeks (P< 0.0001). There was no significant difference in median RW OS among the groups (I: 8.13, II: 8.07, III: 9.02 months, P=0.0532). RW PCS was also similar across categories (I: 7.8, II: 7.5, III: 7.8 months, P=0.88). Adjusted cox regression analysis suggests that compared to TIT of 2-4 weeks, TIT 4-8 weeks was associated with higher RW OS (HR, 0.88, 95% CI 0.8-0.97, P=0.009), but not RW PCS (HR, 0.95, 95% CI 0.87-1.05, P=0.32). Conclusions: This real-world analysis suggests that pre-pandemic, most patients with mPC who receive 1st line therapy were treated within 4 weeks of diagnosis. Compared to TIT of 2-4 weeks, TIT 4-8 weeks was associated with higher RW OS in mPC, although the clinical significance is minimal. In crisis situations, efforts to clinically optimize patients with mPC before systemic therapy should continue to be pursued.