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.
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).
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).
Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment.
Clinical genitourinary cancer. 2020 Jun 22 [Epub ahead of print]
Benjamin W Fischer-Valuck, Jeff M Michalski, Joanna G Harton, Alison Birtle, John P Christodouleas, Jason A Efstathiou, Vivek K Arora, Eric H Kim, Eric M Knoche, Russell K Pachynski, Joel Picus, Yuan James Rao, Melissa Reimers, Bruce J Roth, Paul Sargos, Zachary L Smith, Mohamed S Zaghloul, Hiram A Gay, Sagar A Patel, Brian C Baumann
Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA., Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO., Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK., Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Division of Oncology, Washington University School of Medicine in St Louis, St Louis, MO., Division of Urology, Washington University School of Medicine in St Louis, St Louis, MO., Department of Radiation Oncology, George Washington University, Washington D.C., Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada; Department of Radiotherapy, Institut Bergonié, Bordeaux, France., Radiation Oncology Department, Children's Cancer Hospital, Cairo, Egypt; Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt., Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, MO; Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: .