Thriving in Genitourinary Cancer Treatment During the COVID-19 Pandemic

Clayton Lau, MD

Based on direct experience with facing the COVID-19 pandemic in Medical Oncology and Urology departments, researchers have concluded that the impacts of the pandemic on health care delivery will be lasting. This is especially true for genitourinary (GU) cancers.¹

According to Clayton Lau, MD, GU cancers to date are more likely to be diagnosed in the advanced stages. This impacts treatment options and puts patients at a higher risk for experiencing adverse events.

In an interview with Targeted Oncology™, Lau, chief, Division of Urology and Urologic Oncology, director, Prostate Cancer Program, head, Retroperitoneal Surgery, an associate clinical professor, Department of Surgery at the City of Hope Comprehensive Cancer Center, discussed the impact of COVID-19 on managing GU cancers.

TARGETED ONCOLOGY™: Can you discuss the impact of COVID on prevention and detection of cancer?

During the COVID-19 pandemic, it's been difficult to screen individual patients for things such as breast cancer, colon cancer, and namely genitourinary cancers. Also, patients that have a new diagnosis of bladder cancer and kidney cancer sometimes might have some symptoms of hematuria, flank discomfort, or pain. And because of COVID-19, many patients are not seeking [out] their physicians for their well checks. They might also just overlook it and say, you know, there are other issues going on, it might not be safe to go to the physician’s office to be evaluated.

So, what we're seeing is patients are being delayed in their diagnosis of some of these issues. PSA screening is important for prostate cancer screening, and many patients now instead of getting their PSAs done yearly, or even once every two years, will skip it for a couple of years. This is because of the fact that they're fearful of going to their physician. So, how that translates is that these issues are diagnosed later, and potentially in a different situation than if they were found earlier.

Are there any genitourinary cancers that you would say are more impacted by the setbacks of COVID-19?

Certainly, I would say prostate cancer is the one we see less screening for now. We're seeing a lot of people not getting their regular health checks. Today, we’re also seeing more bladder cancer that's more advanced because patients are still not seeing their doctors if they have little blood in the urine, they might assume that it's from a urine tract infection. So overall, more patients are diagnosed with more advanced stages of bladder cancer and that's becoming more of an issue. Also, for kidney cancer, I would say that we're still seeing quite a bit of kidney cancer these days.

We know that the COVID-19 pandemic has impacted treatment. In the real-world setting, what has been your experience with carrying out surgeries during the pandemic?

It's been a kind of a roller coaster ride? We're still going through this now. But in the beginning, it was very difficult. Number one is how do we do it safely for patients? In the beginning, we were doing only the most aggressive tumors. We had to figure out what our protocols were and what fashion do we intubate or put someone to sleep in a different room if we're moving to where we're going to do the operation? We know that patients that are positive for COVID-19 are likely to have some increased pulmonary complications afterward being under anesthesia.

Now, it's changed quite a bit, especially at the City of Hope, where we specialize in cancer care. We've really made a commitment to try to do take care of the patients that are diagnosed and treat them in a timely fashion, which is hopefully within 30 days. But it's made it more difficult because, number one, we have to get them tested COVID beforehand. But at the same time, we've got to move forward.

At City of Hope, it’s interesting because even with COVID, our volume of surgeries and our volume of treatment of patients, even though it dipped early on for a few weeks, is steady or even above what it was pre-COVID.

Some study protocols require that patients undergo resection prior to receiving targeted therapies. What was the impact of COVID-19 on getting patients ready for treatment in clinical trials?

We've really done a great job in identifying the patients that need to have surgery, in a standard fashion. Typically, surgery occurs within 2 to 3 weeks to 2 to 4 weeks after diagnosis. And we’ve also done a good job getting them into clinical trials. All the trials at the City of Hope are still open. It does make it more difficult for some of the paperwork and the monitoring of patients because of some staffing issues and difficulty in the worry of COVID. But, at least at our institution, we’ve been able to kind of move forward and do the surgeries that we need to do, including for patients who are going to be a part of clinical trials.

Have any of the clinical trials that focus on surgery been impacted by the pandemic?

We have trials that are cytoreductive surgeries, we have imaging studies, and we also have studies looking at techniques. Since our volume is still there, and our support or research staff is still active, I think we're able to still do it. It just takes a little more time and effort. Sometimes it requires the help of more staff, but we all work as a team to kind of move forward with it.

_Reference:

_{Wallis C, Catto J, Finelli A, et al. the impact of the covid-19 pandemic on genitourinary cancer care: re-envisioning the future. Eur Urol. 2020;78(5):731-742. doi: 10.1016/j.eururo.2020.08.030.}