Urologic oncology surgery during COVID-19: a rapid review of current triage guidance documents

Abstract

The Coronavirus Disease 2019 pandemic placed urologic surgeons, and especially urologic oncologists, in an unprecedented situation. Providers and healthcare systems were forced to rapidly create triage schemas in order to preserve resources and reduce potential viral transmission while continuing to provide care for patients. We reviewed United States and international triage proposals from professional societies, peer-reviewed publications, and publicly available institutional guidelines to identify common themes and critical differences. To date, there are varying levels of agreement on the optimal triaging of urologic oncology cases. As the need to preserve resources and prevent viral transmission grows, prioritizing only high priority surgical cases is paramount. A similar approach to prioritization will also be needed as nonemergent cases are allowed to proceed in the coming weeks. While these decisions will often be made on a case-by-case basis, more nuanced surgeon-driven consensus guidelines are needed for the near future.

Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes

“…The prioritization strategies for treatment of various urologic conditions, especially cancers, were based on the criteria and historic knowledge of adverse outcomes from delayed care detailed in Section 2 above. These triage guidelines were reviewed and summarized by Shinder et al, demonstrating general agreement in the recommendations, with some variation [55] . Due to the urgency and need for rapid communication during the early days of the pandemic, none of the initial guidelines and recommendations were based on a formal, systematic review of the literature.…”

Delaying surgery for clinical T1b-T2bN0M0 renal cell carcinoma: Oncologic implications in the COVID-19 era and beyond

“…For oncology patients, delay of definitive treatment may increase the risk of progression to metastatic disease and consequently allow some neoplasms to transform from curable to uncurable [5] . Thus, urologists and kidney cancer patients must understand the effects of treatment delay, both during the COVID-19 pandemic and in the coming months [6] .…”

COVID-19 and Cancer Comorbidity: Therapeutic Opportunities and Challenges

“…Therefore, many health care agencies have altered treatment guidelines on cancer care 144 , 145 . The standard strategy recommended is the prioritization approach, where the risk of hospital admission and the benefit of therapeutic intervention are analyzed and balanced 146 , 147 . The factors that could influence risk/benefit analysis include the patient's health, cancer status, severity, risk factors associated with severe COVID-19 illness, and patient's preferences.…”