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1.
J Cancer Biol ; 2(3): 75-82, 2021.
Article in English | MEDLINE | ID: covidwho-1716519

ABSTRACT

Cancer care has been greatly impacted during the COVID-19 pandemic. The number of cases and deaths caused by the COVID-19 pandemic continues to escalate throughout the United States and the world. Worldwide, over 150 million people have been diagnosed with the coronavirus and more than 3 million have died. Now that we have gained additional experience with COVID-19, we are starting to learn its full impact on oncology care and its effects on the practice of medicine and clinical research.

2.
JAMA Oncol ; 7(10): 1467-1473, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1320053

ABSTRACT

Importance: Early in the COVID-19 pandemic, racial/ethnic minority communities disproportionately experienced poor outcomes; however, the association of the pandemic with prostate cancer (PCa) care is unknown. Objective: To assess the association between race and PCa care delivery for Black and White patients during the first wave of the COVID-19 pandemic. Design, Setting, and Participants: This multicenter, regional, collaborative, retrospective cohort study compared prostatectomy rates between Black and White patients with untreated nonmetastatic PCa during the COVID-19 pandemic (269 patients from March 16 to May 15, 2020) and prior (378 patients from March 11 to May 10, 2019). Main Outcomes and Measures: Prostatectomy rates. Results: Of the 647 men with nonmetastatic PCa, 172 (26.6%) were non-Hispanic Black men, and 475 (73.4%) were non-Hispanic White men. Black men were significantly less likely to undergo prostatectomy during the pandemic compared with White patients (1 of 76 [1.3%] vs 50 of 193 [25.9%]; P < .001), despite similar COVID-19 risk factors, biopsy Gleason grade groups, and comparable prostatectomy rates prior to the pandemic (17 of 96 [17.7%] vs 54 of 282 [19.1%]; P = .75). Black men had higher median prostate-specific antigen levels prior to biopsy (8.8 ng/mL [interquartile range, 5.3-15.2 ng/mL] vs 7.2 ng/mL [interquartile range, 5.1-11.1 ng/mL]; P = .04). A linear combination of regression coefficients with an interaction term for year demonstrated an odds ratio for likelihood of surgery of 0.06 (95% CI, 0.01-0.35; P = .002) for Black patients and 1.41 (95% CI, 0.81-2.44; P = .23) for White patients during the pandemic compared with prior to the pandemic. Changes in surgical volume varied by site (from a 33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery caring for a greater proportion of Black patients. Conclusions and Relevance: In this large multi-institutional regional collaborative cohort study, the odds of PCa surgery were lower among Black patients compared with White patients during the initial wave of the COVID-19 pandemic. Although localized PCa does not require immediate treatment, the lessons from this study suggest systemic inequities within health care and are likely applicable across medical specialties. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the COVID-19 pandemic to develop balanced mitigation strategies as viral rates continue to fluctuate.


Subject(s)
African Americans/statistics & numerical data , COVID-19/epidemiology , Prostatectomy/statistics & numerical data , Prostatic Neoplasms/surgery , /statistics & numerical data , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Neoplasm Grading , Pandemics , Prostatic Neoplasms/ethnology , Prostatic Neoplasms/pathology , Retrospective Studies , United States/ethnology
3.
Urol Oncol ; 39(5): 247-257, 2021 05.
Article in English | MEDLINE | ID: covidwho-880620

ABSTRACT

PURPOSE: During COVID-19, many operating rooms were reserved exclusively for emergent cases. As a result, many elective surgeries for renal cell carcinoma (RCC) were deferred, with an unknown impact on outcomes. Since surveillance is commonplace for small renal masses, we focused on larger, organ-confined RCCs. Our primary endpoint was pT3a upstaging and our secondary endpoint was overall survival. MATERIALS AND METHODS: We retrospectively abstracted cT1b-T2bN0M0 RCC patients from the National Cancer Database, stratifying them by clinical stage and time from diagnosis to surgery. We selected only those patients who underwent surgery. Patients were grouped by having surgery within 1 month, 1-3 months, or >3 months after diagnosis. Logistic regression models measured pT3a upstaging risk. Kaplan Meier curves and Cox proportional hazards models assessed overall survival. RESULTS: A total of 29,746 patients underwent partial or radical nephrectomy. Delaying surgery >3 months after diagnosis did not confer pT3a upstaging risk among cT1b (OR = 0.90; 95% CI: 0.77-1.05, P = 0.170), cT2a (OR = 0.90; 95% CI: 0.69-1.19, P = 0.454), or cT2b (OR = 0.96; 95% CI: 0.62-1.51, P = 0.873). In all clinical stage strata, nonclear cell RCCs were significantly less likely to be upstaged (P <0.001). A sensitivity analysis, performed for delays of <1, 1-3, 3-6, and >6 months, also showed no increase in upstaging risk. CONCLUSION: Delaying surgery up to, and even beyond, 3 months does not significantly increase risk of tumor progression in clinically localized RCC. However, if deciding to delay surgery due to COVID-19, tumor histology, growth kinetics, patient comorbidities, and hospital capacity/resources, should be considered.


Subject(s)
COVID-19/prevention & control , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Medical Oncology/methods , Nephrectomy/methods , SARS-CoV-2/isolation & purification , Aged , COVID-19/epidemiology , COVID-19/virology , Carcinoma, Renal Cell/pathology , Epidemics , Female , Humans , Kaplan-Meier Estimate , Kidney Neoplasms/pathology , Male , Medical Oncology/statistics & numerical data , Middle Aged , Multivariate Analysis , Neoplasm Staging , Retrospective Studies , SARS-CoV-2/physiology , Time-to-Treatment
4.
Urol Oncol ; 39(6): 357-364, 2021 06.
Article in English | MEDLINE | ID: covidwho-808101

ABSTRACT

Coronavirus Disease 2019 has impacted all aspects of urologic training. Didactics have shifted to a virtual platform and new approaches to surgical training have been undertaken. There has been a shift in research away from the laboratory space, with an increased focus on clinical outcomes and multi-institutional collaborations. Finally, there have been impacts on home life, questions about time away from work, case logs and case minimums, as well as how to manage resident and fellow reassignment. Herein, we review the current state of urologic education in the United States, focusing specifically on urologic oncology and highlight opportunities for the future.


Subject(s)
COVID-19/epidemiology , Medical Oncology/education , Urology/education , Education, Distance , Education, Medical, Continuing , Humans , Internship and Residency , SARS-CoV-2 , United States
5.
J Surg Educ ; 78(1): 324-326, 2021.
Article in English | MEDLINE | ID: covidwho-701859

ABSTRACT

The novel coronavirus (COVID-19) pandemic has created many unique challenges in urology resident training. Urologists are operating at a fraction of normal volume to conserve personal protective equipment and prevent viral spread. Many residency programs have organized rotating skeleton crews to perform clinical duties while a portion of residents work from home. In some regions, urology residents have been deployed to emergency rooms, intensive care units, and medical floors to care for COVID-19 patients. With these interruptions in urologic education, many questions remain about how residents will proceed with their clinical and didactic training. During these unprecedented times, many residencies have transitioned their didactic sessions to video-based platforms, allowing educators to reach larger numbers of learners. This perspective addresses how innovative virtual education programs created during the pandemic can be developed into a national video-based curriculum for urology residents, incorporating both didactics and surgical skill training.


Subject(s)
Education, Distance/trends , Education, Medical, Graduate/trends , Urology/education , Videoconferencing , COVID-19/epidemiology , Curriculum , Humans , Internship and Residency , Pandemics , SARS-CoV-2 , United States/epidemiology
6.
Can Urol Assoc J ; 14(6): E271-E273, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-595394
7.
Urol Oncol ; 38(7): 609-614, 2020 07.
Article in English | MEDLINE | ID: covidwho-436799

ABSTRACT

The Coronavirus Disease 2019 pandemic placed urologic surgeons, and especially urologic oncologists, in an unprecedented situation. Providers and healthcare systems were forced to rapidly create triage schemas in order to preserve resources and reduce potential viral transmission while continuing to provide care for patients. We reviewed United States and international triage proposals from professional societies, peer-reviewed publications, and publicly available institutional guidelines to identify common themes and critical differences. To date, there are varying levels of agreement on the optimal triaging of urologic oncology cases. As the need to preserve resources and prevent viral transmission grows, prioritizing only high priority surgical cases is paramount. A similar approach to prioritization will also be needed as nonemergent cases are allowed to proceed in the coming weeks. While these decisions will often be made on a case-by-case basis, more nuanced surgeon-driven consensus guidelines are needed for the near future.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/standards , Urologic Diseases/diagnosis , Urologic Surgical Procedures/standards , COVID-19 , Clinical Decision-Making , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Medical Oncology/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , SARS-CoV-2 , Societies, Medical/standards , Urologic Diseases/surgery , Urology/standards
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