Trends in urologic oncology clinical practice and medical education under COVID-19 pandemic: An international survey of senior clinical and academic urologists

Abstract

Objective: Ad-hoc guidelines for managing the COVID-19 pandemic are published worldwide. We investigated international applications of such policies in the urologic-oncology community.

Methods: A 20-item survey was e-mailed via SurveyMonkey to 100 international senior urologic-oncology surgeons. Leaders' policies regarding clinical/surgical management and medical education were surveyed probing demographics, affiliations, urologic-oncologic areas of interest, and current transportation restrictions. Data on COVID-19 burden were retrieved from the ECDC. Statistical analyses employed non-parametric tests (SPSS v.25.0, IBM).

Results: Of 100 leaders from 17 countries, 63 responded to our survey, with 58 (92%) reporting university and/or cancer-center affiliations. Policies on new-patient visits remained mostly unchanged, while follow-up visits for low-risk diseases were mostly postponed, for example, 83.3% for small renal mass (SRM). Radical prostatectomy was delayed in 76.2% of cases, while maintaining scheduled timing for radical cystectomy (71.7%). Delays were longer in Europe than in the Americas for kidney cancer (SRM follow-up, P = 0.014), prostate cancer (new visits, P = 0.003), and intravesical therapy for intermediate-risk bladder cancer (P = 0.043). In Europe, COVID-19 burden correlated with policy adaptation, for example, nephrectomy delays for T2 disease (r = 0.5, P =0.005). Regarding education policies, trainees' medical education was mainly unchanged, whereas senior urologists' planned attendance at professional meetings dropped from 6 (IQR 1-11) to 2 (IQR 0-5) (P < 0.0001).

Conclusion: Under COVID-19, senior urologic-oncology surgeons worldwide apply risk-stratified approaches to timing of clinical and surgical schedules. Policies regarding trainee education were not significantly affected. We suggest establishment of an international consortium to create a directive for coping with such future challenges to global healthcare.

Keywords: Bladder cancer; COVID-19 pandemic; Kidney cancer; Medical education; Policy; Prostate cancer; Testicular cancer; Urologic oncology.

Fig. 1

Policies of senior urologic-oncology surgeons regarding the timing of clinic visits under the COVID-19 pandemic. Panel A: Kidney cancer clinic policy (Survey question #7). Panel B: Prostate cancer clinic policy (Survey question #8). Panel C: Bladder cancer clinic policy (Survey question #9). Panel D: Testicular cancer clinic policy (Survey question #10). Number of answers to each part of the question is presented under “Total”. Weighted average was calculated according to the following answer key: 1, unchanged; 2, postponed <1 month; 3, postponed 1−3 months; 4, postponed >3months. At the bottom of the figure we present total numbers of answers (not percentages). In the graph we present percentages, calculated per available answers.

Fig. 1

Policies of senior urologic-oncology surgeons regarding the timing of clinic visits under the COVID-19 pandemic. Panel A: Kidney cancer clinic policy (Survey question #7). Panel B: Prostate cancer clinic policy (Survey question #8). Panel C: Bladder cancer clinic policy (Survey question #9). Panel D: Testicular cancer clinic policy (Survey question #10). Number of answers to each part of the question is presented under “Total”. Weighted average was calculated according to the following answer key: 1, unchanged; 2, postponed <1 month; 3, postponed 1−3 months; 4, postponed >3months. At the bottom of the figure we present total numbers of answers (not percentages). In the graph we present percentages, calculated per available answers.

Fig. 2

Policies of senior urologic-oncology surgeons regarding the timing of surgeries under the COVID-19 pandemic. Panel A: Kidney cancer surgery policy (Survey question #11). Panel B: Prostate cancer surgery policy (Survey question #12). Panel C: Bladder cancer surgery policy (Survey question #13). Panel D: Testicular cancer surgery policy (Survey question #14). Number of answers to each part of the question is presented under “Total”. Weighted average was calculated according to the following answer key: 1, unchanged; 2, postponed < 1month; 3, postponed 1−3 months; 4, postponed >3months. At the bottom of the figure we present total numbers of answers (not percentages). In the graph we present percentages, calculated per available answers.

Fig. 2

Policies of senior urologic-oncology surgeons regarding the timing of surgeries under the COVID-19 pandemic. Panel A: Kidney cancer surgery policy (Survey question #11). Panel B: Prostate cancer surgery policy (Survey question #12). Panel C: Bladder cancer surgery policy (Survey question #13). Panel D: Testicular cancer surgery policy (Survey question #14). Number of answers to each part of the question is presented under “Total”. Weighted average was calculated according to the following answer key: 1, unchanged; 2, postponed < 1month; 3, postponed 1−3 months; 4, postponed >3months. At the bottom of the figure we present total numbers of answers (not percentages). In the graph we present percentages, calculated per available answers.

Fig. 3

Policies of senior urologic-oncology surgeons regarding residents’ and fellows’ training sessions (Survey question #18). (Number is calculated as a percentage of 61 available answers.)