ABSTRACT
Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher's exact and Pearson's chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race∗year interaction term. Results: 647 men with untreated nonmetastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.
ABSTRACT
Background: As the coronavirus disease 2019 (COVID-19) pandemic threatens the delivery of cancer care, challenges to providing safe and quality care persist. Screening measures including SARS-CoV-2 polymerase-chain reaction (CovPCR) testing prior to invasive procedures, therapy administration, were instituted to address risk of spread from asymptomatic (AS) pts. Studies have documented poor outcomes with COVID-19 in cancer pts with rate of AS COVID-19 ranging from 0.6%- 8%. (Liang et.al, 2020;Al-Shamsi, et.al, 2020, Shah et.al. 2020). In the general population, rates of AS cases was estimated to be 17% (Byambasuren, O., 2020). This study aimed to examine the incidence and characteristics of AS COVID -19 in cancer pts, and determine its effect on cancer care delivery at a tertiary care center. Methods: With IRB approval, a retrospective chart review was conducted on cancer pts undergoing CoVPCR screening. Pts were considered AS if they had no recent fever (≥100.5 °F), cough, headache, loss of taste/smell, shortness of breath, diarrhea, or high risk exposure. This analysis compared cases (positive CoVPCR) identified by screening of AS pts to control (negative CoVPCR) pts (matched by planned procedure type and month of screening). Each COVID case was matched to 2 negative controls on month and planned procedure type. Patient characteristics and outcomes were compared between cases and controls using conditional logistic regression or Mantel-Haenszel tests. Results: Between 03/2020 and 09/2020, 4143 AS pts underwent CovPCR testing and 75 were chosen for analysis (25 cases;50 controls). The incidence of AS COVID-19 in cancer pts was 0.6% (25/4143). Median age was lower in the cases (64 vs 70y, p = 0.04). Gender, race, primary cancer diagnosis, and co-morbidity distribution was similar between cases and controls. Of the cases, 10 pts (40%) never underwent the planned oncologic intervention while 11 (44%) had a delay related to the positive CoVPCR (2 pts had no intervention planned). Only 1 pt (2%) in control arm didn't undergo the planned procedure. The mean duration of delay was 18 days (range 0-49 days, SD 16.72) in cases versus Zero days in control. Four (16.7%) cases developed symptoms within 14 days of positive CoVPCR testing but the PCR value did not predict this conversion. Conclusions: Incidence of AS COVID in our cancer pts was significantly lower than general population. Active screening delayed oncologic care but with institution of safety measures like separate treatment rooms and scheduling procedures at the end of the day have ensured safe and prompt cancer care delivery during the pandemic. Future research needs will address incorporating vaccination status into the screening algorithm to limit widespread CoVPCR screening, thus improving care delivery and cost effectiveness.