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1.
Innovation in Aging ; 5:462-462, 2021.
Article in English | Web of Science | ID: covidwho-2011308
2.
Journal of Urology ; 207(SUPPL 5):e673, 2022.
Article in English | EMBASE | ID: covidwho-1886525

ABSTRACT

INTRODUCTION AND OBJECTIVE: Access to urologic care can be a significant challenge to rural patients. Due to policy changes related to telemedicine during COVID-19, restrictions on interstate telemedicine were waived by several states beginning in March 2020. The aim of this study is to evaluate telemedicine as a means of extending care to patients in rural areas in a cost-effective manner. We collected information on in-person and telemedicine visits for instate and out-of-state patients to provide insight on delivery of care to rural patients. METHODS: From August 2019 to October 2021, all patients seen for urologic cancer care and related complaints (e.g., elevated PSA) at the University of Washington and Seattle Cancer Care Alliance in-person and via telemedicine were sent a survey after each visit. The survey queried patients about travel time, travel costs, and days of work missed. We compared out-of-state (OOS) patients (patients residing in Oregon, Alaska, Idaho, or Montana) seen in-person with those seen via telemedicine. RESULTS: We collected complete surveys for 1094 patient visits, both in-person (N=207) and telemedicine (N=887), excluding repeat visits for established patients. Among established OOS patients, those receiving care via telemedicine had decreased patientestimated travel costs per appointment compared with those receiving care in-person (80.4% telemedicine vs 4.4% in-person visits patients reported no cost). Similarly, 82.1% of patients receiving care via telemedicine, vs 6.7% of in-person visits, reported $0 in cost for their visit. Telemedicine patients reported fewer missed days of work compared with in-person patients (2+ days of work missed for 7.9% of telemedicine patients vs 40.7% of in-person patients). Median selfreported costs for in-person visits among OOS patients were significantly higher than costs reported by Washington State residents (median $500 vs $50, respectively, p= <0.05). CONCLUSIONS: Telemedicine appointments for urologic oncology care for OOS patients increase access to subspecialty care for rural patients at lower cost. Extending OOS exemptions beyond the COVID-19 telemedicine waivers would permit continued delivery of high-quality urologic cancer care to rural patients.

3.
Journal of Urology ; 207(SUPPL 5):e491, 2022.
Article in English | EMBASE | ID: covidwho-1886510

ABSTRACT

INTRODUCTION AND OBJECTIVE: Patients with non-muscleinvasive bladder cancer (NMIBC) that recurs after treatment with intravesical Bacillus Calmette-Guerin (BCG) must weigh the risk of progression of bladder cancer and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The CISTO Study (NCT03933826) is a pragmatic, prospective observational cohort study comparing medical therapy (i.e., intravesical therapy or systemic immunotherapy) with radical cystectomy for recurrent highrisk NMIBC. Here we report on the design and progress of the CISTO Study. METHODS: 900 patients with recurrent high-risk NMIBC that has failed first-line BCG and who have chosen to undergo standard of care treatment will be enrolled. Patient stakeholders helped determine the primary outcome: 12-month patient-reported QOL using the EORTC QLQ-C30. Secondary outcomes include urinary and sexual function, decisional regret, financial distress, healthcare utilization, return to work/normal activities, progression, and recurrence-free, metastasis-free, and overall survival. Participants will be followed for up to 3 years. RESULTS: Enrollment is active at 32 sites across the US, including 23 university-based centers and 9 community sites. As of November 1, 2021, 173 participants have been enrolled, 104 of whom chose medical therapy and 69 of whom chose radical cystectomy. The completion rate for the primary outcome of QOL at 12 months is 94% (15 out of 16 participants to date). The inclusion of electronic consent and collection of PROs allowed recruitment and follow-up to continue remotely during the COVID-19 pandemic. Significant pandemic-related challenges have included slow study start-up at sites, staffing, periods of suspension, and delays in patients obtaining care. Strategies to address these challenges include improved methods for onboarding and training sites, all-site communication, confirming study eligibility, ing EHR data, and remote monitoring while adhering to the highest study standards. CONCLUSIONS: The CISTO Study will compare patient reported outcomes for those undergoing medical therapy with radical cystectomy for recurrent high-risk NMIBC. The CISTO Study has the potential to fill critical evidence gaps and provide for personalized, patient-centered care.

4.
Journal of Urology ; 207(SUPPL 5):e257, 2022.
Article in English | EMBASE | ID: covidwho-1886490

ABSTRACT

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted various clinical and research processes in urologic care. As part of a pragmatic clinical trial in bladder cancer, we collected information regarding the impact of COVID-19 at participating sites, which provides insight into how the pandemic has imposed constraints on clinical bladder cancer care and research. METHODS: Starting in May 2020, we distributed a monthly survey to sites participating in CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer, NCT0393382). The survey included questions about interruptions in routine clinical bladder cancer care, specifically assessing elective surgery restrictions, impact on radical cystectomy, TURBT, office cystoscopies, intravesical therapy, and intravesical bacillus Calmette- Guerin (BCG) supply. We report survey responses for sites that responded to > 50% of the monthly surveys from May 2020 to October 2021. RESULTS: From May 2020 through October 2021, 21 sites (66%) had > 50% monthly response rate. The time periods of greatest limitations on bladder cancer procedures (Figure 1) were May-July 2020, Dec-Jan 2020/2021, and Sept-Oct 2021, corresponding to the peak waves of COVID-19 infections. Elective surgery was most affected, with limitations or holds in those time periods at up to 76%, 38%, and 28% of CISTO sites, respectively. Most of the restrictions involved surgeries that required inpatient stays, potential intensive care unit admission, and staffing shortages. 9 sites (28%) experienced transient BCG shortages during the survey period. CONCLUSIONS: Clinical activity was most limited during the initial COVID-19 surge in Spring/Summer 2020. Despite higher COVID- 19 infection rates in subsequent waves, bladder cancer clinical activity has been maintained at CISTO sites throughout the COVID pandemic. Periodic BCG shortages continue to affect bladder cancer care across the US. (Figure Presented).

5.
Urology Times ; 48(4), 2020.
Article in English | Scopus | ID: covidwho-911188

ABSTRACT

The State of Emergency for the COVID-19 pandemic has created an environment where urologists can continue to safely provide care through telemedicine. We hope this article helps urologists successfully implement telemedicine and video visits. This will maintain safety both for our patients and for the health care workers in our offices. © 2020 Advanstar Communications Inc.. All rights reserved.

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