Alterations in Genitourinary Cancer Care Due to COVID-19

In a webinar hosted by CancerNetwork®, Judd Moul, MD, urologic oncologist at Duke Cancer Center, Bridget Koontz, MD, radiation oncologist at Duke Cancer Center, Daniel George, MD, medical oncologist at Duke Cancer Center, and John Schweichler, MS, LMFT, a medical family therapist with the Duke Cancer Patient Support Program, came together to discuss the alterations made to genitourinary cancer care due to the coronavirus disease 2019 (COVID-19) pandemic. 

Looking at case studies from various patients Moul has treated during the pandemic, the multidisciplinary group offered insight into the possible alternative choices for treating patients with genitourinary cancers. Overall, the main modification that COVID-19 has forced upon practicing oncologists has been the necessity for delaying various treatments and surgeries, and this was evident throughout the case studies presented.

“I think we all reacted very aggressively and undoubtedly that’s made a difference in our patient population at Duke,” said George. “Over half of my clinic was either cancelled or deferred or changed to telephone visits on that first day, and by the next week, it was probably three quarters of the patients that were either video, telephoned or deferred.” 

Moul indicated that some of his patients have made the decision on their own to delay treatment, with 1 patient even opting for active surveillance rather than his originally planned surgery. According to George, he has seen some of his long-term patients who had initially planned to do further lines of therapy decide that alternative options that will not put them at risk of further complications, such as hospice, are the better choice.

“I think this COVID fear has had some implications on how people accept alternative management in a way that’s not necessarily all bad,” said George. “Some of that is actually changing a perspective that maybe they should have had from the beginning.” 

In addition to modifying typical treatment options, Moul expressed the difficulty he has had in communicating the necessity for treatment shifts to some individuals, with a few patients even expressing great frustration at having to completely shift their course of treatment. Moreover, Schweichler highlighted the difficulty that healthcare providers are currently facing when communicating these changes to patients.

“As we’re navigating how you handle a new treatment, and particularly [androgen deprivation therapy; ADT] which can have all kinds of physical but also emotional side effects and changes on treatment, I think it’s important to consider an early referral to a support person or a social worker, whatever services you have available,” explained Schweichler. “Be honest with where you’re sending folks, but I think this kind of situation puts the providers in a tough spot. You know, you’re having to communicate a loss of a choice in a sense or not being able to pursue a pathway you might be able to and that’s a hard thing to do.” 

In helping patients to make the best decisions for themselves during the pandemic, Koontz placed an emphasis on fully educating patients about their treatment options. According to Koontz, although there are many difficult decisions that are having to be made by clinicians, patient’s must also be well informed to make the best decisions for themselves. 

“I think part of it is just getting an understanding of what their concerns are and then, you know, maybe there’s another rational for why they think that they want surgery or why they think that they want radiation, and if that’s appropriate, great,” said Koontz. “If I’m concerned that they may be missing part of the story or an important piece of information that they’re not aware of, then I provide that and then it’s sort of up to them to decide what to do.”

“I think a lot of times it’s that they’ve only heard a piece of the story and we can usually help to educate and help them, you know, really empower that patient, to make a good decision that’s right for their body,” Koontz continued.