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Author Notes:

Correspondence: Brian C. Baumann, MD, Department of Radiation Oncology, Washington University School of Medicine in St Louis, 660 S Euclid Ave, Campus Box 8224, St Louis, MO 63110. Fax: (314) 362-7769

Disclosures: The authors have stated that they have no conflict of interest.

Subjects:

Research Funding:

None declared

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Urology & Nephrology
  • ChemoRT MIBC
  • COVID-19 bladder cancer
  • Delays in chemoRT MIBC
  • MIBC
  • Pandemic treatment delays MIBC
  • Radical cystectomy
  • Neoadjuvant chemotherapy
  • Cell carcinoma
  • Diagnosis
  • Time

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

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Journal Title:

Clinical Genitourinary Cancer

Volume:

Volume 19, Number 1

Publisher:

, Pages 41-+

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

ª 2020 Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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