Management of Muscle-Invasive Bladder Cancer During a Pandemic: Impact of Treatment Delay on Survival Outcomes for Patients Treated With Definitive Concurrent Chemoradiotherapy

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

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: 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. Patients and Methods: 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). Results: 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). Conclusion: Although these results are limited and require validation, short, strategic treatment delays during a pandemic can be considered on the basis of clinician judgment. Limited data are available on the effect of treatment delays for initiating chemoradiotherapy (CRT) for muscle-invasive bladder cancer. We used the National Cancer Database and found that 1387 patients had started CRT < 90 days after transurethral resection of bladder tumor (TURBT) compared with 197 with delayed CRT (≥ 90 days after TURBT). On multivariable analysis, delayed CRT was not associated with differences in overall survival. These results suggest that short, strategic treatment delays during a pandemic can be considered based on clinician judgment.

Original languageEnglish
Pages (from-to)41-46.e1
JournalClinical Genitourinary Cancer
Volume19
Issue number1
DOIs
StatePublished - Feb 2021

Keywords

  • COVID-19 bladder cancer
  • ChemoRT MIBC
  • Delays in chemoRT MIBC
  • MIBC
  • Pandemic treatment delays MIBC

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