New Research Examines Disruption of Urologic Cancer Referral Patterns Caused by COVID-19

A research effort led by members of the Department of Urology at UPMC and the University of Pittsburgh School of Medicine sought to uncover changes or disruptions in the referral patterns for patients either needing to be screened for urologic malignancies or with a new cancer diagnosis caused by the COVID-19 pandemic. Their study¹ was published in December 2020 in the journal Urologic Oncology: Seminars and Original Investigations.

Avinash Maganty, MD, a resident physician in the Department of Urology, was the first author of the study. Bruce L. Jacobs, MD, MPH, was the senior author of the investigation.

“COVID-19 has and continues to disrupt everyday life. Health care systems and workers have seen unprecedented strains on their day-to-day operations. Our team wanted to better understand how the pandemic affected patient referrals for new or suspected cases of urologic cancers, and also screenings for conditions such as prostate cancer,” says Dr. Maganty.

The study examined and compared referral patterns and case volumes for the immediate three-month period before the beginning of the pandemic (defined for this study as March 17 based on Commonwealth of Pennsylvania guidelines and state-wide mandatory closures of all nonessential services) and during the first three months of the COVID-19 pandemic.

Dr. Maganty’s team conducted a retrospective study to identify the number of patients seen for either urologic cancer screening or a new urologic cancer diagnosis before and during COVID-19. The ”during COVID-19” period was stratified into three tiers – red, yellow, and green – based on phases established by the Commonwealth of Pennsylvania that generally indicate levels of disease activity and corresponding mitigation plans, including allowed activities by residents and businesses. The red phase in Allegheny county ran from March 17 – May 14; the yellow phase from May 15 – June 4; and the green phase from 6/5 to the end of the study period (6/30). The research team also examined numerous patient-specific factors such as age, race, and geography to determine if referral pattern changes were more prevalent among certain patients.

In the three months prior to COVID-19, the urologic oncology practice in the Department saw 585 new patients for either screening or a new cancer diagnosis. In the three months after the start of the pandemic, the Department saw 362 patients, amounting to a 38% decrease in volume.

“This was a significant decrease in volume in our practice initially, but given all that was transpiring with the pandemic early on, this was not surprising,” says Dr. Jacobs. “Volume appeared to reach pre-COVID-19 levels within about 3 months.”

During the initial red phase of the pandemic, there was a significant decrease in referral volumes across all types of cancer. Kidney and bladder cancer volumes nearly returned to pre-COVID levels once the Commonwealth of Pennsylvania reached its green phase of mitigation activities. However, the return of volumes for prostate cancer were less than for the other types. This discrepancy may reflect the less aggressive or indolent nature of prostate cancer in general. The analysis did not find any significant changes in the patient populations referred before and during COVID-19. 

While it is clear that patients were delaying visits during the initial pandemic surge, what is not clear-- and what will require further study-- is the consequences of such delays to patient health, morbidity, and mortality.

Full details of the study can be accessed through the link below.

Reference

1. Maganty A, Yu M, Anyaeche VI, Zhu T, Hay JM, Davies BJ, Yabes JG, Jacobs BL. Referral Pattern for Urologic Malignancies Before and During the COVID-19 Pandemic. Urol Oncol. 2020 Dec 8; S1078-1439(20)3061401. Epub ahead of print.