Management of muscle-invasive bladder cancer during a pandemic: Impact of treatment delay on survival outcomes for patients treated with definitive concurrent chemoradiation

Fischer-Valuck, Benjamin W.; Michalski, Jeff M.; Harton, Joanna G.; Birtle, Alison; Christodouleas, John P.; Efstathiou, Jason A.; Arora, Vivek K.; Kim, Eric H.; Knoche, Eric M.; Pachynski, Russell K.; Picus, Joel; Rao, Yuan James; Reimers, Melissa; Roth, Bruce J.; Sargos, Paul; Smith, Zachary L.; Zaghloul, Mohamed S.; Gay, Hiram A.; Patel, Sagar A.; Baumann, Brian C.

INTRODUCTION: During the COVID-19 pandemic, providers and patients must engage in shared decision-making to ensure that the benefit of early intervention for muscle-invasive bladder cancer (MIBC) exceeds the risk of contracting COVID-19 in the clinic setting. It is unknown whether treatment delays for MIBC patients eligible for curative chemoradiation (CRT) compromise long-term outcomes. PATIENTS AND METHODS: In this study, we used the National Cancer Database to investigate if there is an association between a ≥90-day delay from TURBT in initiating CRT and overall survival (OS). We included patients with cT2-4N0M0 MIBC from 2004-2015 who underwent TURBT and curative-intent concurrent CRT. Patients were grouped based on timing of CRT: ≤89 days after TURBT (‘earlier’) vs. ≥ 90 & <180 days after TURBT (‘delayed’). RESULTS: 1,387 (87.5%) received ‘earlier’ CRT (median 45 days post-TURBT, IQR: 34-59 days) and 197 (12.5%) received ‘delayed’ CRT (median 111 days post-TURBT, IQR: 98-130 days). Median OS was 29.0 months (95% CI, 26.0-32.0) versus 27.0 months (95% CI, 19.75-34.24) for ‘earlier’ and ‘delayed’ CRT, respectively (p=0.94). On multivariable analysis, delayed CRT was not associated with an OS difference: hazard ratio, 1.05 (95% CI, 0.87-1.27); p=0.60. CONCLUSION: While these results are limited and require validation, short strategic treatment delays during a pandemic can be considered based on clinician judgement.