The Impact of the COVID-19 Pandemic on Genitourinary Cancer Care: Re-envisioning the Future.

The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward.

To provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic.

A collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families.

Patterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement.

The COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care.

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.

European urology. 2020 Sep 03 [Epub ahead of print]

Christopher J D Wallis, James W F Catto, Antonio Finelli, Adam W Glaser, John L Gore, Stacy Loeb, Todd M Morgan, Alicia K Morgans, Nicolas Mottet, Richard Neal, Tim O'Brien, Anobel Y Odisho, Thomas Powles, Ted A Skolarus, Angela B Smith, Bernadett Szabados, Zachary Klaassen, Daniel E Spratt

Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ., Academic Urology Unit, University of Sheffield, Sheffield, UK., Division of Urology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada., Leeds Institute of Medical Research, University of Leeds, Leeds, UK., Department of Urology, University of Washington, Seattle, WA, USA., Department of Urology and Population Health, NYU Langone Health and Manhattan Veterans Affairs, New York, NY, USA., Department of Urology, University of Michigan, Ann Arbor, MI, USA., Department of Medical Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Department of Urology, University Hospital Nord, St Etienne, France., Leeds Institute of Health Sciences, University of Leeds, Leeds, UK., Department of Urology, Guy's and St Thomas Hospitals, London, UK., Department of Urology and Center for Digital Health Innovation, University of California San Francisco, San Francisco, CA, USA., Barts Cancer Center, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK., Department of Urology, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA., Department of Urology, University of North Carolina, Chapel Hill, NC, USA., Department of Surgery, Division of Urology, Augusta University-Medical College of Georgia, Augusta, GA, USA., Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.