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Mangone L, Marinelli F, Bisceglia I, Filice A, Braghiroli MB, Roncaglia F, Palicelli A, Morabito F, Neri A, Sabbatini R, Iotti C, Pinto C. Impact of the COVID-19 Pandemic on Prostate Cancer Diagnosis, Staging, and Treatment: A Population-Based Study in Northern Italy. BIOLOGY 2024; 13:499. [PMID: 39056693 PMCID: PMC11274002 DOI: 10.3390/biology13070499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
The COVID-19 pandemic has caused delays in cancer diagnoses and reductions in treatments. The aim of this work is to evaluate the impact of the pandemic on prostate cancer by evaluating whether there has been a shift towards more aggressive (Gleason) and more advanced tumors (stage IV) and a decline in treatments. The study was conducted on 1123 cases of prostate cancer incident in the Province of Reggio Emilia, Northern Italy, in the period of 2018-2021. In 2020, there was a decline in new diagnoses of prostate cancer (-31%), followed by a slight recovery in 2021 (+5%). While Gleason 7 and 8-10 values remained constant, a significant decrease was recorded in stage I (38.7%, 41.6%, 35.5%, and 27.7%) and an increase in stage IV (13.1%, 13%, 15.4%, and 20%) cases in the years 2018, 2019, 2020, and 2021, respectively. However, there was no impact on surgical treatment (which remained constant at around 35%) and radiotherapy (around 39%). Our findings underline the profound impact of COVID-19 on prostate cancer management, highlighting the importance of healthcare resilience in the face of unprecedented disruptions.
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Affiliation(s)
- Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (F.R.)
| | - Francesco Marinelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (F.R.)
| | - Isabella Bisceglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (F.R.)
| | - Angelina Filice
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Maria Barbara Braghiroli
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (F.R.)
| | - Francesca Roncaglia
- Epidemiology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (F.M.); (I.B.); (M.B.B.); (F.R.)
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Fortunato Morabito
- Gruppo Amici Dell’Ematologia Foundation—GrADE, 42123 Reggio Emilia, Italy;
| | - Antonino Neri
- Scientific Directorate, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Roberto Sabbatini
- Medical Oncology Division, Department of Oncology and Hematology, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Cinzia Iotti
- Radiation Oncology Unit, Department of Advanced Technology, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Carmine Pinto
- Medical Oncology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
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Botelho F, Lopes R, Pina F, Silva C, Pacheco-Figueiredo L, Lunet N. Prostate cancer treatment in Portugal: a nationwide analysis. Sci Rep 2023; 13:19362. [PMID: 37938598 PMCID: PMC10632360 DOI: 10.1038/s41598-023-46591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
Different treatment options exist for localized prostate cancer. Treatments performed in high-volume hospitals are associated with better results. Our objective was to describe time trends in prostate cancer treatments in Portugal and case volume per hospital. We used the national database of diagnosis-related group of the Portuguese Central Administration of the Health System to describe the number of radical prostatectomy (RP), brachytherapy (BT) and external radiotherapy (eRT) treatments performed in all National Health System hospitals. There was a rapid increase in the annual number of RP until 2006 and then a deceleration; BT treatments augmented significantly until 2011. The utilization of eRT also increased, surpassing RP after 2010. From the 46 hospitals performing RP, only eight had a case-volume > 50 treatments/year, and from the nine hospitals performing BT, only four accomplished > 15 treatments/year. In the 11 hospitals with eRT, nine performed > 50/year. Regarding RP, there was negative correlation between the hospital volume and length of stay (r = - 0.303; p = 0.041). In the Portuguese National Health Service there was a steep increase in the number of prostate cancer treatments, and there is an ample margin for concentration of RP and BT treatments, for improvement of the hospitals case volume.
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Affiliation(s)
- Francisco Botelho
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal.
- Instituto de Investigação em Ciências da Vida e Saúde - ICVS/3B's Laboratório Associado, Escola de Medicina, Universidade do Minho, Braga, Portugal.
| | - Rui Lopes
- Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Francisco Pina
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Departamento de Urologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carlos Silva
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Departamento de Urologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luís Pacheco-Figueiredo
- Serviço de Urologia do Centro Hospitalar Universitário S. João, Alameda Hernâni Monteiro, 4200-319, Porto, Portugal
- Instituto de Investigação em Ciências da Vida e Saúde - ICVS/3B's Laboratório Associado, Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Nuno Lunet
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Mostafavi Zadeh SM, Tajik F, Gheytanchi E, Kiani J, Ghods R, Madjd Z. COVID-19 pandemic impact on screening and diagnosis of prostate cancer: a systematic review. BMJ Support Palliat Care 2023:spcare-2023-004310. [PMID: 37748857 DOI: 10.1136/spcare-2023-004310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The healthcare level has been greatly affected by the COVID-19 pandemic compared with before the outbreak. This study aimed to review the impact of COVID-19 on the screening and diagnosis of prostate cancer (PCa). METHOD The current study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The keywords used to perform the search strategy were COVID-19 and prostate neoplasms. The four primary electronic databases comprising PubMed/MEDLINE, Web of Science, Scopus and Embase were searched until 1 September 2022. After screening and selecting studies through the EndNote software, data were extracted from each included study by two independent authors. All studies were evaluated according to Newcastle-Ottawa Scale quality assessment tool. RESULTS As a result, 40 studies were included, categorised into two subjects. The majority of studies indicated a significant decrease in screening prostate-specific antibody tests during the COVID-19 pandemic compared with the pre-pandemic period, leading to delays in cancer diagnosis. The decrease in the number of diagnosed cases with low/intermediate stages to some extent was more than those with advanced stages. The PCa screening and diagnosis reduction ranged from nearly 0% to 78% and from 4.1% to 71.7%, respectively. CONCLUSION Our findings showed that during the COVID-19 lockdown, delays in PCa screening tests and diagnoses led to the negative health effects on patients with PCa. Thus, it is highly recommended performing regular cancer screening to reduce the impact of the COVID-19 lockdown. PROSPERO REGISTRATION NUMBER CRD42021291656.
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Affiliation(s)
- Seyed Mostafa Mostafavi Zadeh
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Molecular Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Tajik
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Elmira Gheytanchi
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Kiani
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Molecular Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Ghods
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Molecular Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Madjd
- Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Molecular Medicine, Iran University of Medical Sciences, Tehran, Iran
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Robinson D, Abdulkareem R, Nasrollah D, Ljung A, Hintze P, Wallby S, Ståhlbrandt H, Frennvall T, Styrke J, Stattin P, Garmo H. Frequency of Biopsy and Tumor Grade Before vs After Introduction of Prostate Magnetic Resonance Imaging. JAMA Netw Open 2023; 6:e2330233. [PMID: 37606924 PMCID: PMC10445184 DOI: 10.1001/jamanetworkopen.2023.30233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023] Open
Abstract
Importance In randomized clinical trials (RCTs), magnetic resonance imaging (MRI) before prostate biopsy has been associated with fewer biopsies, decreased detection of Gleason score 6 cancers, and increased detection of Gleason score 7 or higher cancers. Objective To study whether MRI of the prostate before the decision to biopsy is associated with biopsy frequency and distribution of Gleason score in clinical practice. Design, Setting, and Participants This is a retrospective, population-based cohort study of men in Jönköping Region, Sweden. Men with prostate-specific antigen (PSA) level measured between November 2011 and 2020 were monitored until January 31, 2021. Men with known prostate cancer were excluded. Data analysis was performed from July to December 2022. Exposures Data on repeated PSA measures, prostate biopsies, and MRI prostate were extracted from health care records, and cancer characteristics were obtained from The National Prostate Cancer Register. Main Outcomes and Measures The proportions of men who underwent prostate biopsy and risk of Gleason score 6 or Gleason score 7 or higher cancer and negative biopsy before and after introduction of MRI were calculated. Results In this cohort study of 23 802 men (mean [SD] age, 60.8 [13.6] years) who underwent PSA testing, when the use of MRI increased, fewer biopsies were performed (adjusted odds ratio [OR], 0.84; 95% CI, 0.72-0.97) and the odds of detecting Gleason score 6 cancer decreased (OR, 0.47; 95% CI, 0.33-0.64), whereas the odds of detecting Gleason score 7 or higher cancer increased (OR, 1.24; 95% CI, 1.02-1.50). Conclusions and Relevance In this study, the introduction of MRI to clinical practice was associated with a decreased proportion of men who underwent a biopsy and decreased detection of Gleason score 6 cancer but increased detection of Gleason score 7 or higher cancer. These clinical data support the use of prostate MRI before biopsy in an effort to avoid unnecessary biopsies.
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Affiliation(s)
| | | | | | - Anders Ljung
- Department of Radiology, Highland Hospital, Eksjö, Sweden
| | - Per Hintze
- Department of Radiology, Highland Hospital, Eksjö, Sweden
| | - Sara Wallby
- Department of Radiology, Highland Hospital, Eksjö, Sweden
| | | | - Thorun Frennvall
- Department of Pathology, Ryhov County Hospital, Jönköping, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Sweden
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Tufvesson Stiller H, Schmitt-Egenolf M, Fohlin H, Uppugunduri S. Patient reported experiences of Swedish patients being investigated for cancer during the Covid-19 pandemic. Support Care Cancer 2023; 31:416. [PMID: 37354327 DOI: 10.1007/s00520-023-07897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Patient reported experiences in individuals being investigated for cancer have been recorded in a nationwide survey in Sweden, providing an opportunity to assess the impact of the Covid-19-pandemic. MATERIAL AND METHODS Questionnaires from 45920 patients were analyzed to assess the experience of being investigated for cancer. Data from before the Covid-19-pandemic (2018-2019) was compared to data acquired during the pandemic (2020-2021), using chi-square and Wilcoxon rank sum tests. Both, patients who were cleared from suspicion of cancer and those who were diagnosed with cancer were included. RESULTS Fewer patients in total visited health services during the pandemic. However, patients that did seek help did so to a similar extent during as prior to the pandemic. Patient waiting time was perceived to be shorter during the pandemic and judged as neither too long nor too short by most patients. The emotional support to patients improved during the pandemic, whereas the support to next of kin declined. A majority of patients received the results from the investigation in a meeting with the physician. Although there was a preference for receiving results in a meeting with the physician, the pandemic has brought an increasing interest in receiving results by phone. CONCLUSION Swedish cancer healthcare has shown resilience during the Covid-19-pandemic, maintaining high patient satisfaction while working under conditions of extraordinary pressure. Patients became more open to alternatives to physical "in person" health care visits which could lead to more digital visits in the future. However, support to significant others demands special attention.
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Affiliation(s)
- Helena Tufvesson Stiller
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- Regional Cancer Center Southeast, Linköping, Sweden.
| | | | - Helena Fohlin
- Regional Cancer Center Southeast, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Srinivas Uppugunduri
- Regional Cancer Center Southeast, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Ramírez-Soto MC, Salazar-Peña M, Vargas-Herrera J. Estimating Excess Mortality Due to Prostate, Breast, and Uterus Cancer during the COVID-19 Pandemic in Peru: A Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5156. [PMID: 36982065 PMCID: PMC10049374 DOI: 10.3390/ijerph20065156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/27/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, most of the deaths in Peru were related to COVID-19; however, cancer deaths have also been exacerbated in the first months of the pandemic. Despite this, excess mortalities of prostate, breast, and uterus cancer are not available by age group and region from January to December 2020. Therefore, we estimated the excess deaths and excess death rates (per 100,000 habitants) due to prostate, breast, and uterus cancer in 25 Peruvian regions. We did a time series analysis. Prostate, breast, and uterus cancer death data for 25 Peruvian regions were retrieved during the COVID-19 pandemic in 2020, as well as data for up to 3 years prior (2017-2019) from the Sistema Informatico Nacional de Defunciones at the Ministry of Health of Peru. Deaths in 2020 were defined as observed deaths. The expected deaths (in 2020) were estimated using the average deaths over 3 preceding years (2017, 2018 and 2019). Excess mortality was calculated as the difference between observed mortality and expected mortality in 2020. We estimated that the number of excess deaths and the excess death rates due to prostate, breast, and uterus cancer were 610 deaths (55%; 12.8 deaths per 100,000 men), 443 deaths (43%; 6 deaths per 100,000 women), and 154 deaths (25%; 2 deaths per 100,000 women), respectively. Excess numbers of deaths and excess death rates due to prostate and breast cancer increased with age. These excess deaths were higher in men aged ≥ 80 years (596 deaths (64%) and 150 deaths per 100,000 men) and women aged 70-79 years (229 deaths (58%) and 15 deaths per 100,000 women), respectively. In summary, during the COVID-19 pandemic, there were excess prostate and breast cancer mortalities in 2020 in Peru, while excess uterus cancer mortalities were low. Age-stratified excess death rates for prostate cancer and breast cancer were higher in men ≥ 80 years and in women ≥ 70 years, respectively.
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Affiliation(s)
| | | | - Javier Vargas-Herrera
- Unidad de Telemedicina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima 15001, Peru;
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Taheri D, Jahanshahi F, Khajavi A, Kafi F, Pouramini A, Farsani RM, Alizadeh Y, Akbarzadeh M, Reis LO, Khatami F, Aghamir SMK. The Impact of Covid-19 Pandemic on Genitourinary Cancers Stage and Grade. Clin Genitourin Cancer 2023; 21:84-90. [PMID: 36517394 PMCID: PMC9684093 DOI: 10.1016/j.clgc.2022.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Our study aims to evaluate the impact of the COVID-19 pandemic on the number of uro-oncological surgeries (cystectomy, nephrectomy, prostatectomy, orchiectomy, and transurethral resection of bladder tumor (TURBT)) and pathological staging and grading. MATERIALS AND METHODS The present study is a retrospective study on patients with genitourinary cancers treated from 2018 to 2021 in a referral tertiary center. The data were obtained from the hospital records with lengths of 22 and 23 months, labeled hereafter as non-COVID and COVID pandemic, respectively (2018/3/21-2020/1/20 and 2020/1/21-2021/12/21). The total number of registered patients, gender, age, stage, and grade were compared in the targeted periods. Moreover, all the pathologic slides were reviewed by an expert uropathologist before enrolling in the study. The continuous and discrete variables are reported as mean (standard deviation (SD)) and number (percent) and the χ2 test for the comparison of the discrete variables' distribution. RESULTS In this study total number of 2077 patients were enrolled. The number of procedures performed decreased during the Covid pandemic. The tumors' distribution stage and grade and patients' baseline characteristics were not significantly different in non-COVID and COVID pandemic periods for Radical Nephrectomy, Radical Cystectomy, Radical Prostatectomy, and orchiectomy. For TURBT only, the tumor stage was significantly different (P-value<.001) from the higher stages in the COVID pandemic period. CONCLUSION Among urinary tract cancers, staging of bladder cancer and TURBT are mainly impacted by the COVID-19 pandemic with higher stages compared to the non-COVID period. We evaluate the impact of the COVID-19 pandemic on the number of uro-oncological surgeries based on pathological staging and grading. Total number of 2077 patients were enrolled. Among urinary tract cancers, staging of bladder cancer and TURBT are mainly impacted by the COVID-19 pandemic with higher stages compared to the non-COVID period.
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Affiliation(s)
- Diana Taheri
- Isfahan Kidney Disease Research Center, Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran,Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Jahanshahi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Research Committee Member, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kafi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouramini
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza M. Farsani
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Akbarzadeh
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Leonardo O. Reis
- UroScience and Department of Surgery (Urology), School of Medical Sciences, University of Campinas, Unicamp, and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brazil
| | - Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Muacevic A, Adler JR. The Impact of the COVID-19 Pandemic on Surgical Activities: A Single-Center Experience and Literature Review. Cureus 2022; 14:e30785. [PMID: 36447702 PMCID: PMC9701314 DOI: 10.7759/cureus.30785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/25/2023] Open
Abstract
Aim The aim of this article is to investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on our surgical department, which is situated in Athens, Greece, as well as to review published literature on the COVID-19 pandemic's impact on surgical activities in our department. Material and methods We retrospectively reviewed the surgical procedures that were performed in the surgical department of a tertiary University hospital in Athens, Greece, before and during the pandemic. Furthermore, we performed a literature review evaluating articles on surgical activity and COVID-19 published from the beginning of the pandemic up until the January of 2022 on the PubMed database. Results In total, 894 patients were included in the study. Of those, 264 (29.5%) underwent surgery during the control period and 630 (70.5%) in the pandemic period. Overall, we performed 20.5% fewer surgeries in the post-sanitary period. In particular, elective surgeries decreased on average by 23.9%, emergency procedures decreased by 8.9%, and oncology surgeries increased by an average of 6.4% after the year 2020. Concerning the review of literature, 51 studies were selected for this review. According to them, the main effect of the pandemic on the surgical sector was reflected in the reduction of total surgeries, mainly due to the postponement of elective surgical procedures, which showed a median reduction of 54% compared to the pre-COVID-19 period. A smaller decrease was observed in the number of emergency and oncological surgeries. Conclusions Reduced surgical activity during the pandemic, due to the health measures imposed, requires courageous corrective interventions to avoid its adverse effects, such as disease progression, increased treatment costs, reduced quality of life, and ultimately the survival of the patients.
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Bratt O, Carlsson S, Fransson P, Thellenberg Karlsson C, Stranne J, Kindblom J. The Swedish national guidelines on prostate cancer, part 1: early detection, diagnostics, staging, patient support and primary management of non-metastatic disease. Scand J Urol 2022; 56:265-273. [PMID: 35811480 DOI: 10.1080/21681805.2022.2094462] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE There is now an unprecedented amount of evidence to consider when revising prostate cancer guidelines. We believe that there is a value in publishing summaries of national clinical guidelines in English for others to read and comment on. METHODS This is part 1 of a summary of the Swedish prostate cancer guidelines that were published in June 2022. It covers the early detection, diagnostics, staging, patient support and management of the non-metastatic disease. Part 2 covers recurrence after local treatment and management of the metastatic disease. RESULTS The 2022 Swedish guidelines include several new recommendations: rectal iodine-povidone to reduce post-biopsy infections, external beam radiation with focal boost to the tumour, use of a pre-rectal spacer to reduce rectal side effects after external beam radiotherapy in some expert centres, 6 months' concomitant and adjuvant rather than neoadjuvant and concomitant hormonal treatment together with radiotherapy for unfavourable intermediate and high-risk disease, and adjuvant abiraterone plus prednisolone together with a GnRH agonist for a subgroup of men with very high-risk disease. The Swedish guidelines differ from the European by having more restrictive recommendations regarding genetic testing and pelvic lymph node dissection, the risk group classification, recommending ultra-hypofractionated (7 fractions) external radiotherapy for intermediate and selected high-risk cancers, by not recommending any hormonal treatment together with radiotherapy for favourable intermediate-risk disease, and by recommending bicalutamide monotherapy instead of a GnRH agonist for some patient groups. CONCLUSIONS The 2022 Swedish prostate cancer guidelines include several new recommendations and some that differ from the European guidelines.
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Affiliation(s)
- Ola Bratt
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden
| | - Stefan Carlsson
- Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Johan Stranne
- Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden.,Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Göteborg, Sweden
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden
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Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment. PLoS One 2022; 17:e0269827. [PMID: 35700180 PMCID: PMC9197019 DOI: 10.1371/journal.pone.0269827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/27/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines.
Materials and methods
To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses.
Results
A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate.
Conclusion
While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.
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van Hoogstraten LM, Kiemeney LA, Meijer RP, van Leenders GJ, Vanneste BG, Incrocci L, Smilde TJ, Siesling S, Witjes JA, Aben KK. The Impact of the COVID-19 Pandemic on Bladder Cancer Care in the Netherlands. Bladder Cancer 2022; 8:139-154. [PMID: 38993368 PMCID: PMC11181832 DOI: 10.3233/blc-211608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/24/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. OBJECTIVE To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. METHODS The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. RESULTS During the first COVID wave (week 9-22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17-22 (OR = 0.62, 95% CI = 0.40-0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. CONCLUSIONS The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.
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Affiliation(s)
- Lisa M.C. van Hoogstraten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lambertus A. Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MCCancer Institute, Rotterdam, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Katja K.H. Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - on behalf of the BlaZIB study group and the COVID and Cancer-NL consortium
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiation Oncology, MAASTRO-clinic, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Radiation Oncology, Erasmus MCCancer Institute, Rotterdam, the Netherlands
- Department of Medical Oncology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
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12
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Ezenwankwo EF, Nnate DA, Oladoyinbo CA, Dogo HM, Idowu AA, Onyeso CP, Ogo CN, Ogunsanya M, Bamidele O, Nnaji CA. Strengthening Capacity for Prostate Cancer Early Diagnosis in West Africa Amidst the COVID-19 Pandemic: A Realist Approach to Rethinking and Operationalizing the World Health Organization 2017 Guide to Cancer Early Diagnosis. Ann Glob Health 2022; 88:29. [PMID: 35646616 PMCID: PMC9104562 DOI: 10.5334/aogh.3519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two years after SARS-CoV-2 (COVID-19) was declared a global public health emergency, the restoration, at least, to the pre-pandemic level of early diagnostic services for prostate cancer has remained enormously challenging for many health systems, worldwide. This is particularly true of West Africa as the region grapples also with the broader impacts of changing demographics and overly stretched healthcare systems. With the lingering COVID-19 crisis, it is likely that the current trend of late prostate cancer diagnosis in the region will worsen with a concomitant increase in the burden of the disease. There is, therefore, a compelling need for innovative and evidence-based solutions to de-escalate the current situation and forestall the collapse of existing structures supporting early prostate cancer diagnosis in the region. In this viewpoint, we make a case for the operationalization of the World Health Organization (WHO) guide to early cancer diagnosis to strengthen the capacity for early prostate cancer diagnosis in West Africa using a realist approach, drawing on participatory health research and evidence-based co-creation. Ultimately, we demonstrate the potential for developing COVID-19 responsive and context-specific models to optimize patient navigation/journey along the essential steps of the World Health Organization guide to early cancer diagnosis.
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Affiliation(s)
- Elochukwu Fortune Ezenwankwo
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- African Behavioral Research (ABeR) Center, Federal University of Agriculture, Abeokuta, Nigeria
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Daniel A. Nnate
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Catherine Adebukola Oladoyinbo
- African Behavioral Research (ABeR) Center, Federal University of Agriculture, Abeokuta, Nigeria
- Department of Nutrition and Dietetics, Federal University of Agriculture, Abeokuta, Nigeria
| | - Hassan Mohammed Dogo
- African Behavioral Research (ABeR) Center, Federal University of Agriculture, Abeokuta, Nigeria
- Department of Surgery, Urology Division, University of Maiduguri, Maiduguri, Nigeria
| | - Ademola Amos Idowu
- African Behavioral Research (ABeR) Center, Federal University of Agriculture, Abeokuta, Nigeria
- Department of Chemical Pathology, Ekiti State University College of Medicine, Ado-Ekiti, Nigeria
| | | | - Chidiebere Ndukwe Ogo
- Department of Surgery, Federal Medical Centre Abeokuta, NG
- African Behavioral Research (ABeR) Center, Federal Univeristy of Agriculture, Abeokuta, Nigeria
| | - Motolani Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, 1110 N. Stonewall Ave, Oklahoma City, US
| | - Olufikayo Bamidele
- Institute for Clinical and Applied Health Research, Hull York Medical School, R341, University of Hull, UK
| | - Chukwudi A. Nnaji
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town 7501, South Africa
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13
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Ebner B, Volz Y, Mumm JN, Stief CG, Magistro G. The COVID-19 pandemic - what have urologists learned? Nat Rev Urol 2022; 19:344-356. [PMID: 35418709 PMCID: PMC9007269 DOI: 10.1038/s41585-022-00586-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 12/18/2022]
Abstract
On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.
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Affiliation(s)
- Benedikt Ebner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Yannic Volz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Jan-Niclas Mumm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
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14
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Johansson AL, Larønningen S, Skovlund CW, Kristiansen MF, Mørch LS, Friis S, Johannesen TB, Myklebust TÅ, Skog A, Pettersson D, Birgisson H, Virtanen A, Malila N, Pitkäniemi J, Tanskanen T, Tryggvadóttir L, Ursin G, Lambe M. The impact of the COVID-19 pandemic on cancer diagnosis based on pathology notifications: A comparison across the Nordic countries during 2020. Int J Cancer 2022; 151:381-395. [PMID: 35419824 PMCID: PMC9087674 DOI: 10.1002/ijc.34029] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in-situ tumors from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a non-significant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in-situ tumors. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.
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Affiliation(s)
- Anna Lv Johansson
- Cancer Registry of Norway, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marnar Fríðheim Kristiansen
- Center of Health Science, Faculty of Health Sciences, Tórshavn, Faroe Islands.,National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Lina Steinrud Mørch
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | | | - Tor Åge Myklebust
- Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Anna Skog
- Cancer Registry of Norway, Oslo, Norway
| | | | - Helgi Birgisson
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland
| | - Anni Virtanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland.,Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tomas Tanskanen
- Finnish Cancer Registry, Cancer Society of Finland, Helsinki, Finland
| | - Laufey Tryggvadóttir
- Cancer Registry of Iceland, Icelandic Cancer Society, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.,Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center Central Sweden, Uppsala, Sweden
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15
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Impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. Cancer Treat Res Commun 2022; 31:100553. [PMID: 35421819 PMCID: PMC8975755 DOI: 10.1016/j.ctarc.2022.100553] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022]
Abstract
Introduction The COVID-19 outbreak has affected care for non-COVID diseases like cancer. We evaluated the impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. Methods Prostate cancer diagnoses per month in 2020–2021 versus 2018–2019 were compared based on preliminary data of the Netherlands Cancer Registry (NCR) and nationwide pathology network. Detailed data was retrieved from the NCR for the cohorts diagnosed from March-May 2020 (first COVID-19 wave) and March-May 2018–2019 (reference). Changes in number of diagnoses, age, disease stage and first-line treatment were compared. Results An initial decline of 17% in prostate cancer diagnoses during the first COVID-19 wave was observed. From May onwards the number of diagnoses started to restore to approximately 95% of the expected number by the end of 2020. Stage at diagnosis remainedstable over time. In low-risk localised prostate cancer radical prostatectomy was conducted more often in week 9–12 (21% versus 12% in the reference period; OR=1.9, 95% CI; 1.2–3.1) and less active surveillance was applied (67% versus 78%; OR=0.6, 95% CI; 0.4–0.9). In the intermediate-risk group, a similar change was observed in week 13–16. Radical prostatectomy volumes in 2020 were comparable to 2018–2019. Conclusion During the first COVID-19 wave the number of prostate cancer diagnoses declined. In the second half of 2020 this largely restored although the number remained lower than expected. Changes in treatment were temporary and compliant with adapted guidelines. Although delayed diagnoses could result in a less favourable stage distribution, possibly affecting survival, this seems not very likely.
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16
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Liakos N, Witt JH, Rachubinski P, Leyh-Bannurah SR. The Dilemma of Misclassification Rates in Senior Patients With Prostate Cancer, Who Were Treated With Robot-Assisted Radical Prostatectomy: Implications for Patient Counseling and Diagnostics. Front Surg 2022; 9:838477. [PMID: 35252339 PMCID: PMC8888518 DOI: 10.3389/fsurg.2022.838477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES There is a recent paradigm shift to extend robot-assisted radical prostatectomy (RARP) to very senior prostate cancer (PCa) patients based on biological fitness, comorbidities, and clinical PCa assessment that approximates the true risk of progression. Thus, we aimed to assess misclassification rates between clinical vs. pathological PCa burden. MATERIALS AND METHODS We compared senior patients with PCa ≥75 y (n = 847), who were propensity score matched with younger patients <75 y (n = 3,388) in a 1:4 ratio. Matching was based on the number of biopsy cores, prostate volume, and preoperative Cancer of the Prostate Risk Assessment (CAPRA) risk groups score. Multivariable logistic regression models (LRMs) predicted surgical CAPRA (CAPRA-S) upgrade, which was defined as a higher risk of the CAPRA-S in the presence of lower-risk preoperative CAPRA score. LRM incorporated the same variables as propensity score matching. Moreover, patients were categorized as low-, intermediate-, and high-risk, preoperative and according to their CAPRA and CAPRA-S scores. RESULTS Surgical CAPRA risk strata significantly differed between the groups. Greater proportions of unfavorable intermediate risk (39 vs. 32%) or high risk (30 vs. 28%; p < 0.001) were observed. These proportions are driven by greater proportions of International Society of Urological Pathology (ISUP) Gleason Grade Group 4 or 5 (33 vs. 26%; p = 0.001) and pathological tumor stage (≥T3a 54 vs. 45%; p < 0.001). Increasing age was identified as an independent predictor of CAPRA-S-based upgrade (age odds ratio [OR] 1.028 95% CI 1.02-1.037; p < 0.001). CONCLUSION Approximately every second senior patient has a misclassification in (i.e., any up or downgrade) and each 4.5th senior patient specifically has an upgrade in his final pathology that directly translates to an unfavorable PCa prognosis. It is imperative to take such substantial misclassification rates into account for this sensitive PCa demographic of senior men. Future prospective studies are warranted to further optimize PCa workflow and diagnostics, such as to incorporate modern imaging, molecular profiling and implement these into biopsy strategies to identify true PCa burden.
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Affiliation(s)
- Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
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17
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Bower H, Frisell T, di Giuseppe D, Delcoigne B, Ahlenius GM, Baecklund E, Chatzidionysiou K, Feltelius N, Forsblad-d'Elia H, Kastbom A, Klareskog L, Lindqvist E, Lindström U, Turesson C, Sjowall C, Askling J. Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision. RMD Open 2021; 7:rmdopen-2021-001987. [PMID: 34880127 PMCID: PMC8655349 DOI: 10.1136/rmdopen-2021-001987] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision. Methods Through nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015–2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities. Results Based on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (−7%), visits to rheumatology units (−16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and −8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends. Conclusions Patients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.
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Affiliation(s)
- Hannah Bower
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frisell
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniela di Giuseppe
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Bénédicte Delcoigne
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gerd-Marfie Ahlenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå Universitet, Umeå, Sweden
| | - Eva Baecklund
- Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Nils Feltelius
- Swedish Medical Products Agency, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alf Kastbom
- Department of Biomedical and Clinical Sciences, Linkopings Universitet, Linkoping, Sweden
| | - Lars Klareskog
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden
| | - Ulf Lindström
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Christopher Sjowall
- Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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18
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Pfaff JAR, Harlan ME, Pfaff G, Hubert A, Bendszus M. Neuroradiological emergency consultations during the first year of the COVID-19 pandemic. Neurol Res Pract 2021; 3:47. [PMID: 34455980 PMCID: PMC8403519 DOI: 10.1186/s42466-021-00147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Measures taking aim at minimizing the risk of coronavirus transmission and fear of infection may affect decisions to seek care for other medical emergency conditions. The purpose of this analysis was to analyze intermediate-term effects of the COVID-19 pandemic on neuroradiological emergency consultations (NECs). METHODS We conducted an ambispective study on NEC requests to a university hospital from a teleradiological network covering 13 hospitals in Germany. Weekly NEC rates for prepandemic calendar weeks (CW) 01/2019-09/2020 were compared with rates during first COVID-19 wave (CW 10-20/2020), first loosening of restrictions (CW 21-29/2020), intensified COVID-19 testing (CW 30-39/2020) and second COVID-19 wave (CW 40-53/2020), and contrasted with COVID-19 incidence in Germany. RESULTS A total of n = 10 810 NECs were analyzed. Prepandemic NEC rates were stable over time (median: 103, IQR: 97-115). Upon the first COVID-19 wave in Germany, NEC rates declined sharply (median: 86, IQR: 69-92; p < 0.001) but recovered within weeks. Changes in NEC rates after first loosening of restrictions (median: 109, IQR: 98-127; p = 0. 188), a phase of intensified testing (median: 111, IQR: 101-114; p = 0.434) and as of a second COVID-19 wave (median: 102, IQR: 94-112; p = 0. 462) were not significant. Likewise, patient age and gender distribution remained constant. CONCLUSION Upon the first pandemic COVID-19 wave in Germany, NEC rates declined but recovered within weeks. It is unknown whether this recovery reflects improved medical care and test capabilities or an adjustment of the patients' behaviour.
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Affiliation(s)
- Johannes A. R. Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- University Institute for Neuroradiology of the Paracelsus Medical University, Uniklinikum Salzburg, Christian-Doppler-Klinik, Ignaz-Harrer-Straße 79, A-5020 Salzburg, Austria
| | - Marcial E. Harlan
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Günter Pfaff
- Visiting Lecturer in Epidemiology and Psychiatric Epidemiology, Protestant University of Applied Sciences Ludwigsburg, Paulusweg 6, 71638 Ludwigsburg, Germany
| | - Alexander Hubert
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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