ABSTRACT
Introduction According to international publications the COVID-19 pandemic led to a delay in the medical treatment of different diseases. The purpose of our investigation was to evaluate the incidence and the stage of head and neck cancer in the period from 01/2020-12/2021. These data were compared to that before the pandemic in the time period from 01/2018-12/2019. Method Using our oncological documentation system, a monocentric analysis of the number of tumor diagnosis and tumor stages at initial diagnosis was carried out looking at the 2-year pandemic period from 2020-2021. The purpose of the investigation was to determine whether there was a pandemic-related delay in treatment of oncological patients in our clinic. Results The analysis showed no decrease in the number of new tumor cases in the pandemic years 2020-2021 compared to the years 2018-2019. Furthermore, no shift towards more advanced tumor stages during the COVID-19 pandemic could be determined. Conclusion Occasionally the COVID-19 pandemic led to delayed tumor diagnosis and treatment, which resulted in a worse outcome for many patients. This effect could be turned around by accurate appointment planning taking tumor suspected cases under consideration. Furthermore, special office hours particularly for tumor cases even in times of a lockdown including video consultations when appropriate and patient awareness campaigns led to a favorable patient care.
ABSTRACT
Background: Management of non-muscle invasive bladder cancer (NMIBC) is expensive with negative quality-of-life effects due to requirement for multiple transurethral resection/biopsies under general/regional anaesthetic;especially in those with low-and intermediate-risk NMIBC due to their low risk of progression but high recurrence rate (>30%). Pressures on the National Health Service, which is exacerbated by the COVID-19 pandemic, means safe, efficient and cost-effective solutions are required. We present our experience of transurethral laser ablation (TULA) in a large single tertiary unit. Patients and Methods: A retrospective review of electronic records of all TULA cases with available 3-month cystoscopy follow-up results between October 2019 and February 2021 were included. Data analysed included: patient demographics, co-morbidities (Charleston comorbidity index score-CCIS), anticoagulation, initial histopathological data, tumour number/size, procedural tolerance, post-procedure complications, 3-month recurrence rate and cost savings of outpatient TULA versus inpatient bladder cancer surgery. Results: Fifty patients with a median age of 75 years (range: 55-96) were identified. Median CCIS was 4 (range: 1-7) with only 10 patients on anticoagulation which was not stopped pre-procedure. The most common initial histopathological diagnosis was low-grade G2pTa TCC (n = 32). Median number of tumours treated were 2 (range: 1-9) ranging from 0.5 to 3 cm. Only one patient did not tolerate TULA and was listed for GA bladder biopsy. No complications were noted. Three-month recurrence rate was 11/49 (22%). Outpatient TULA saved £33,600 compared to inpatient bladder cancer surgery, and this does not account for other efficiency savings such as reducing waiting lists and avoiding protracted hospital admissions in elderly co-morbid patients. Conclusion: TULA is a safe and well-tolerated procedure. It is a cost-effective option for the treatment of low-risk NMIBC patients and also those deemed unfit for general/regional anaesthesia. Larger case series are needed to assess its long-term outcomes.