Ad-hoc guidelines for managing the COVID-19 pandemic are published worldwide. We investigated international applications of such policies in the urologic-oncology community.
A 20-item survey was e-mailed via SurveyMonkey to 100 international senior urologic-oncology surgeons. Leaders' policies regarding clinical/surgical management and medical education were surveyed probing demographics, affiliations, urologic-oncologic areas of interest, and current transportation restrictions. Data on COVID-19 burden were retrieved from the ECDC. Statistical analyses employed non-parametric tests (SPSS v.25.0, IBM).
Of 100 leaders from 17 countries, 63 responded to our survey, with 58 (92%) reporting university and/or cancer-center affiliations. Policies on new-patient visits remained mostly unchanged, while follow-up visits for low-risk diseases were mostly postponed, for example, 83.3% for small renal mass (SRM). Radical prostatectomy was delayed in 76.2% of cases, while maintaining scheduled timing for radical cystectomy (71.7%). Delays were longer in Europe than in the Americas for kidney cancer (SRM follow-up, P = 0.014), prostate cancer (new visits, P = 0.003), and intravesical therapy for intermediate-risk bladder cancer (P = 0.043). In Europe, COVID-19 burden correlated with policy adaptation, for example, nephrectomy delays for T2 disease (r = 0.5, P =0.005). Regarding education policies, trainees' medical education was mainly unchanged, whereas senior urologists' planned attendance at professional meetings dropped from 6 (IQR 1-11) to 2 (IQR 0-5) (P < 0.0001).
Under COVID-19, senior urologic-oncology surgeons worldwide apply risk-stratified approaches to timing of clinical and surgical schedules. Policies regarding trainee education were not significantly affected. We suggest establishment of an international consortium to create a directive for coping with such future challenges to global healthcare.
Urologic oncology. 2020 Oct 06 [Epub ahead of print]
Barak Rosenzweig, Axel Bex, Zohar A Dotan, Mark Frydenberg, Laurence Klotz, Yair Lotan, Claude C Schulman, Igor Tsaur, Jacob Ramon
Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2013, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Electronic address: ., UCL Division of Surgery and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK., Department of Urology, Chaim Sheba Medical Center, Ramat Gan, Israel, The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel., Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia., Division of Urology, University of Toronto, Toronto, Ontario, Canada., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Clinic E Cavell and University of Brussels, Brussels, Belgium., Department of Urology, University Hospital of Mainz, Mainz, Germany.