Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy

• Type of Material: Article
• Authors: Benjamin Fischer-Valuck, Emory University; Jeff M. Michalski, Washington University; Joanna G. Harton, University of Pennsylvania; Alison Birtle, Lancashire Teaching Hospital NHS Foundation Trust; John P. Christodouleas, University of Pennsylvania; Jason A. Efstathiou, Massachusetts General Hospital; Vivek K. Arora, Washington University; Eric H. Kim, Washington University; Eric M. Knoche, Washington University; Russell K. Pachynski, Washington University; Joel Picus, Washington University; Yuan J. Rao, George Washington University; Melissa Reimers, Washington University; Bruce J. Roth, Washington University; Paul Sargos, Jewish General Hospital; Zachary L. Smith, Washington University; Mohamed S. Zaghloul, Children’s Cancer Hospital, Cairo, Egypt; Hiram A. Gay, Washington University; Sagar Patel, Emory University; Brian C. Baumann, Washington University
• Language: English
• Date: 2021-02-01
• Publisher: CIG Media Group LP.
• Publication Version: Final Published Version
• Copyright Statement: ª 2020 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.clgc.2020.06.005
• Title of Journal or Parent Work: Clinical Genitourinary Cancer
• Volume: 19
• Issue: 1
• Start Page: 41
• End Page: +
• Grant/Funding Information: None declared
• Keywords: Time; Urology & Nephrology; Cell carcinoma; Science & Technology; MIBC; ChemoRT MIBC; Neoadjuvant chemotherapy; Oncology; Radical cystectomy; Pandemic treatment delays MIBC; Life Sciences & Biomedicine; COVID-19 bladder cancer; Diagnosis; Delays in chemoRT MIBC
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Immunology; Health Sciences, Oncology; Biology, Cell

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 and Methods 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.