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Título

Surviving the Storm: Challenges of Bladder Cancer Care During the COVID-19 Pandemic

Resumo

PURPOSE: To evaluate the impact of the COVID-19 pandemic on the care of patients with bladder cancer in a tertiary oncology center.

INTRODUCTION: In this study, we postulated that the COVID-19 pandemic might have affected the management of bladder cancer patients, potentially resulting in a poorer oncological prognosis. To evaluate the influence of COVID-19 on the treatment of bladder cancer patients, we conducted an analysis comparing the clinical and epidemiological characteristics, along with the oncological outcomes, of patients treated in the years 2019, 2020, 2021, and 2022. To the best of our knowledge, this is the only study in Latin American literature that compares the profile and management of patients with bladder cancer in a pre- and post-pandemic period

MATERIALS AND METHOD: Oncological services were affected, resulting in a decrease in the number of patients diagnosed, referred, and treated. This decline was more pronounced at the onset of the pandemic, with a reduction of up to 22.1% compared to the pre-pandemic year. We performed a retrospective analysis of patients admitted to a tertiary cancer center to treat bladder cancer between 2019 and 2022. Surgical volumes, patient demographics, clinical characteristics, and postoperative outcomes were compared across these years.

RESULTS: A total of 463 patients with bladder cancer were admitted in the period, and 78 patients underwent radical cystectomy (RC). The distribution of TMN stages between admitted patients remained consistent across the years, with no statistically significant differences. Patients who underwent RC in 2020 presented more advanced disease at surgery (pT3/pT4 stage) (p = 0.045; 95% CI 0.18 to 0.55) and had a more extended hospital stay compared to other years (p=0.024; 95% CI 10.26 - 41.27). The use of neoadjuvant chemotherapy showed a significant increase over the study period (p < 0.001; 95%CI -0.16 to -0.02) and the majority of patients in 2020 completing four cycles (51%), while a larger proportion in 2019 and subsequent years received fewer than four cycles.

CONCLUSIONS: The COVID-19 pandemic posed significant challenges for the treatment of patients with bladder cancer. These results highlight the need to adapt health systems to unforeseen challenges, emphasizing the clinical impact on patients with advanced stages of the disease and the repercussions on their overall survival.

Palavras Chave

Bladder cancer; COVID-19 Pandemics; urologic surgical procedures;