ABSTRACT
The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.
Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , SARS-CoV-2/isolation & purification , Urogenital Neoplasms/surgery , Urologic Neoplasms/surgery , Urologic Surgical Procedures/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Humans , Male , Medical Oncology/statistics & numerical data , Middle Aged , Neoplasm Staging , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Pandemics , Penile Neoplasms/pathology , Penile Neoplasms/surgery , SARS-CoV-2/physiology , Testicular Neoplasms/pathology , Testicular Neoplasms/surgery , Time-to-Treatment , Urogenital Neoplasms/pathology , Urologic Neoplasms/pathologyABSTRACT
The COVID-19 pandemic has overwhelmed hospitals all over the world. To reduce the risk of transmission of COVID-19 and meet the increasing mental health demands due to this trauma, psychiatry outpatient services have gone online in various countries. We describe steps taken at a tertiary care hospital in Karachi, Pakistan, to start these services during this pandemic. We also discuss the obstacles faced. (PsycInfo Database Record (c) 2020 APA, all rights reserved).