The Impact of COVID-19 Pandemic on the Referral Pattern of Patients with Urologic Malignancies - Expert Commentary

The COVID-19 pandemic has led to significant changes in the healthcare system. Although it is expected that the diagnosis of cancer care may be delayed, the exact impact on the referral pattern of patients with urologic malignancies is unknown.

A recent study by Maganty et al. published in Urologic Oncology examined differences in patient referral patterns for potential urologic cancer diagnosis before and during the COVID-19 pandemic. The authors conducted a retrospective analysis of patients presenting with a possible new cancer diagnosis to the urologic oncology clinic at the University of Pittsburgh Medical Center.

The study included 947 patients presenting for potential prostate, bladder, or kidney cancer evaluation. The authors used the date when Pennsylvania began a statewide shut down in March 2020 as the cutoff date. The pre-COVID-19 cohort was seen three to five months prior to this date, and the COVID-19 cohort was seen three to five months after this date.

A total of 585 new patients were seen for cancer screening or new diagnosis in the pre-COVID19, and 362 patients were seen within the COVID-19 period, resulting in a 38% decline in the visits. The authors stratified the new patient visits during the COVID-19 period by phases (red, yellow, green) of county re-opening and found that prostate cancer was the only organ site that continued to have reduced visits per week compared to the pre-COVID-19 levels in the green phase.

The study tried to explore the impact of COVID-19 on traditionally underserved and vulnerable populations such as rural residents, minorities, the elderly, and those of lower socioeconomic status but did not identify significant differences using regression analysis. Although the test positivity for Pennsylvania was low (up to 7% positivity) compared to other states there was a significant decline in the referral of new patients with suspected urologic malignancies. Delays in referral can lead to treatment delays. Studies to characterize the impact of COVID-19 related treatment delays are required.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York


  1. Maganty, Avinash, Michelle Yu, Vivian I. Anyaeche, Toby Zhu, Jordan M. Hay, Benjamin J. Davies, Jonathan G. Yabes, and Bruce L. Jacobs. "Referral pattern for urologic malignancies before and during the COVID-19 pandemic." In Urologic Oncology: Seminars and Original Investigations. Elsevier, 2020.
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