Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy.
Clin Genitourin Cancer
; 19(1): 41-46.e1, 2021 02.
Article
in English
| MEDLINE | ID: covidwho-926856
ABSTRACT
INTRODUCTION:
During the coronavirus disease 2019 (COVID-19) pandemic, providers and patients must engage in shared decision making to ensure that the benefit of early intervention for muscle-invasive bladder cancer exceeds the risk of contracting COVID-19 in the clinical setting. It is unknown whether treatment delays for patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. PATIENTS ANDMETHODS:
We used the National Cancer Data Base to investigate whether there is an association between a ≥ 90-day delay from transurethral resection of bladder tumor (TURBT) in initiating CRT and overall survival. We included patients with cT2-4N0M0 muscle-invasive bladder cancer from 2004 to 2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped on the basis of timing of CRT ≤ 89 days after TURBT (earlier) vs. ≥ 90 and < 180 days after TURBT (delayed).RESULTS:
A total of 1387 (87.5%) received earlier CRT (median, 45 days after TURBT; interquartile range, 34-59 days), and 197 (12.5%) received delayed CRT (median, 111 days after TURBT; interquartile range, 98-130 days). Median overall survival was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for earlier and delayed CRT (P = .94). On multivariable analysis, delayed CRT was not associated with an overall survival difference (hazard ratio, 1.05; 95% CI, 0.87-1.27; P = .60).CONCLUSION:
Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Urinary Bladder Neoplasms
/
Chemoradiotherapy, Adjuvant
/
Time-to-Treatment
/
Decision Making, Shared
/
COVID-19
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Language:
English
Journal:
Clin Genitourin Cancer
Journal subject:
Neoplasms
/
Urology
Year:
2021
Document Type:
Article
Affiliation country:
J.clgc.2020.06.005
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