Abstract
Background: COVID-19 has been a challenge for health systems worldwide. Many hospitals were converted into COVID-19 centers, including our center. Diagnostic studies, ambulatory procedures, and elective surgeries were canceled, and emergency care and inpatient services were closed for patients without COVID-19. Lack of access to hospital services represents a problem in the care of cancer, especially in low- and middle-income countries (LMICs). Our aim was to analyze the impact of hospital conversion to a COVID-19 center on the follow-up and management of patients in our urologic oncology clinic.
Methods: We analyzed data of all patients in our urologic oncology clinic with appointments scheduled from March 16th to May 31st. A fellow reviewed all cases to evaluate if appointments were eligible for regular visit, telemedicine, or postponement and patients were contacted. Demographic, disease, and treatment characteristics were obtained. Population was analyzed according to type of visit (standard of care vs. clinical trial). We examined univariate associations between groups. A p-value ≤0.05 indicated statistical significance.
Results: A total of 336 patients were included; the median age was 65 (18-94) years, and 306 (91.1%) were men. The main neoplasms were prostate (49.4%), kidney (20.2%), germ cell tumors (21.4%), urothelial (8.6%), and penile (0.3%) cancer. 46.7% of patients were in active treatment, and 11.9% were enrolled in a clinical trial. Remote communication was established with 184/224 (82.1%) patients. We planned to reschedule the visits of 224/336 (66.7%) patients. Medical appointments were rescheduled to a median of 91 days (IQR 65-105 days). All patients enrolled in clinical trials visited the clinic as scheduled. Among patients eligible for telemedicine, 105 (46.9%) were on surveillance, 68 (30.4%) on hormone therapy, 45 (20.1%) on no active treatment, and 6 (2.7%) on other therapy. The majority of the 111 patients who had an in-person appointment were receiving chemotherapy (24.3%), followed by immunotherapy (15.3%), targeted therapy (15.3%), and hormone therapy (13.5%). 13.5% had no active treatment and 9.0% were on surveillance. Comparing non-protocol versus protocol patients, we found a significant difference in loss of follow-up (12.2% vs 0% p = 0.012). During the study period, two (0.6%) confirmed cases and one (0.3%) death due to COVID-19 were recorded.
Conclusions: In our initial experience, rescheduling of visits and remote follow-up was possible in most patients during hospital conversion to a COVID-19 center. Despite the constrained resources and communication barriers of LMICs, the rate of patients lost to follow-up was not increased during the pandemic in our center. Telemedicine was possible, particularly for those on surveillance and hormone therapy. Comparing standard clinical care versus clinical trial patients, we found a significant difference in terms of loss to follow-up.
Citation Format: Salvador G. Santiesteban, Haydee Verduzco-Aguirre, Christianne Bourlon, Maria T. Bourlon. Impact of a hospital conversion to COVID-19 center on cancer care of patients in a urologic oncology clinic in Mexico [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-019.
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