Page 1 - Flipbook

CONSENSUS STATEMENT

A Canadian framework for managing prostate cancer during the

COVID-19 pandemic: Recommendations from the Canadian Urologic

Oncology Group and the Canadian Urological Association

Andrea Kokorovic, MD ; Alan I. So, MD ; Sebastien J. Hotte, MD ; Peter C. Black, MD ; Brita Danielson, MD ;
2
1
4
2
3
Urban Emmenegger, MD ; Antonio Finelli, MD ; Tamim Niazi, MD ; Frederic Pouliot, MD ; Bobby Shayegan, MD ;
8
9
7
6
5
Srikala Sridhar, MD ; Eric Vigneault, MD ; Andrew Loblaw, MD ; Ricardo A. Rendon, MD 13
12
11
10
2
3
1 The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Juravinski Cancer Centre,
McMaster University, Hamilton, ON, Canada; Department of Oncology, Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada; Department of Medical Oncology, Sunnybrook Odette
4
5
7
6
Cancer Centre, Toronto, ON, Canada; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Department of Oncology, Division of Radiation Oncology, McGill University, Montreal
10
9
QC, Canada; Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada; Division of Urology, McMaster University, Hamilton, ON, Canada; Division of Hematology and Medical
8
11
Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, CHUQ, Université Laval, Quebec City, QC, Canada;
13
12 Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada; Department of Urology, Dalhousie University, Halifax, NS, Canada
Cite as: Can Urol Assoc J 2020;14(6):163-8. http://dx.doi.org/10.5489/cuaj.6667 General principles
Published online April 28, 2020 1. This consensus statement is a guide to help physicians
manage prostate cancer during the acute phase of a pan-
demic. Treatment prioritization must take into account
Introduction regional differences in infection rates, resource capacity,
and mitigation efforts. The current pandemic has had
a widespread reach across all Canadian communities,
The COVID-19 pandemic has had an unprecedented impact but we recognize that the degree of impact varies, and
on all aspects of healthcare. One widespread strategy to miti- that provincial and institutional policies are not uni-
gate the burden of disease is to limit non-essential exposure to form. Physicians must continue to monitor a continu-
healthcare settings by cancelling office visits and non-emergent ously evolving situation and make adjustments to clinical
surgeries. The underlying concern is that there is an unknown decisions as deemed appropriate.
proportion of patients and staff who are asymptomatic carriers 2. The risk of serious morbidity resulting from SARS-
and testing capacity is insufficient to test everyone. 1 CoV-2 infection may outweigh the competing risk of
The COVID-19 pandemic presents a unique challenge for prostate cancer in many men. Observation of prostate
oncology for several reasons. Patients with cancer might be cancer in carefully selected patients does not increase
more likely to get COVID-19 and have serious adverse out- long-term mortality 10,11 and, therefore, short-term treat-
comes, including intensive care admissions, ventilator require- ment delays are unlikely to lead to disease progression
2,3
ments, and death. Furthermore, patients undergoing surgery, and worse outcomes. All management decisions should
including select oncological cases, may be at high risk for post- be based on this core principle.
4
operative mortality. In addition, intubation is a procedure that 3. Appropriate patient counselling and shared decision-
carries high risk of spreading the virus to members of the health- making is strongly encouraged. Men diagnosed with
care team present in the operating room. These complexities in prostate cancer have increased anxiety and psychologi-
cancer care have resulted in the release of several guidelines cal distress. 12,13 This will undeniably become amplified
regarding management of oncology patients during the COVID- in the setting of a global health crisis. Despite resource
19 era. Two recent Canadian Urological Association (CUA) restrictions and changes in treatment recommenda-
5-9
publications outline recommendations on surgical triaging and tions, physicians must continue to address the needs of
the use of systemic therapies in genitourinary malignancies. 7,9 patients and involve them in the decision-making pro-
The purpose of this publication is to provide a multidisci- cess. This approach may decrease patient anxiety levels
plinary framework focused on prostate cancer management and improve outcomes once regular practice resumes.
in the setting of the COVID-19 global pandemic within the
Canadian context.
CUAJ • June 2020 • Volume 14, Issue 6 163
© 2020 Canadian Urological Association