AUA 2022: Patient-Reported Delays in Treatment for Urologic Cancers During the COVID-19 Pandemic: A National Cross-Sectional Analysis

( In a podium presentation at the 2022 American Urologic Association Annual Meeting held in New Orleans and virtually, Dr. Jacob Lang discussed patient reported delays in urologic cancer treatment as a result of the COVID-19 pandemic.

It would be hard to overstate the effect the COVID-19 pandemic has had on medical care. An extensive body of literature has shown that there were dramatic decreases in access to care, screening and diagnostic testing, and surgical treatment during the initial phases of the pandemic. However, the overall impact on care and survival has not yet been fully appreciated. In their study, Dr. Lang and colleagues assessed patient reported delays in treatment or ancillary care due to the pandemic for the two most common urologic cancers, prostate cancer and bladder cancer at the national level.

To do so, they used the National Health Interview Survey 2020 to perform a retrospective, cross-sectional study. This dataset includes a nationally representative sample of 31,568 adults 18 or older which, combined with weightings to account for the complex survey design, provides national estimates. The authors identified patients with a history of prostate or bladder cancer and examined the proportion of patients reporting changes, delays, or cancellations to cancer treatment or other ancillary care during the pandemic.

With the NHIS weighting approach, a sample-weighted estimate of 1,720,245 patients with history of prostate cancer (n=1,439,867, 83.7%) or bladder (n=280,379, 16.3%) of known treatment or other care status during Covid-19 were included. Among these, 282,929 (16.5%) reported receiving or supposed to be receiving treatment since the start of the pandemic, while 298,116 (17.3%) reported needing other care including lab visits, imaging, monitoring visits, rehabilitation, physical therapy, care for side-effects, or visits with medical specialists.

Among those patients who reported receiving or supposed to be receiving treatment, 76,984 (27.2%; 95% CI 15.7-43.0%) reported their cancer treatment was changed, delayed, or canceled due to the pandemic, with no significant difference between those with history of prostate cancer and bladder cancer (27.2% vs. 27.5%; P=.99). Of those needing other care, 73,189 (24.5%; 95% CI 13.8-39.7%) reported change, delay, or cancellation due to the pandemic, again with no significant difference between patients with history of prostate or bladder cancer (24.4% vs. 26.0%; P=0.93).

Thus, the authors conclude that approximately one-quarter of patients with prostate or bladder cancer requiring treatment or other ancillary care during the pandemic reported change, delay, or cancellation. Delays in bladder cancer treatment, particularly, have previously been shown to increase mortality, thus necessitating further study of the long-term implications of delays due to the Covid-19 pandemic on outcomes.

Presented by: Jacob Lang, MSc, University of Toledo College of Medicine and Life Sciences, Toledo, OH

Written by: Christopher J.D. Wallis, University of Toronto Twitter: @WallisCJD during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.

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