Access to medical care for men with prostate cancer was sharply reduced last year during the COVID-19 pandemic, according to real-world data from Verana Health and the American Urological Association (AUA) presented at the American Society of Clinical Oncology 2021 virtual annual meeting.
A total of 267,691 patients with prostate cancer visited 158 US urology providers within the AUA’s Quality (AQUA) registry during 2019 and 2020. From March 2 to November 1, 2020 (week 10 to week 44) the magnitude of the decline and recovery in health care visits, including telehealth, varied by prostate cancer risk category, with the steepest drops observed for low-risk prostate cancer, Matthew R. Cooperberg, MD, MPH, of the University of California, San Francisco, and colleagues reported.
For the first 9 weeks of 2020, health care providers had 25.6 mean visits per day, similar to 2019. Visits declined from weeks 10 to 14 (early March to the first week of April) to 18.03 per day — a 31% drop compared with 2019. Visits recovered to 2019 levels by week 23 (early June 2020), then declined to 11.89 per day by week 44 — a 58% drop from the same period in 2019.
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For low-risk prostate cancer, mean visits per day declined from 6.57 at week 10 to 4.49 at week 14, rebounded to a peak of 7.04, then declined again to a new low of 3.62 at week 44, Dr Cooperberg’s team reported. Intermediate-risk prostate cancer visits followed the same temporal trend. Mean visits per day declined from 9.68 at week 10 to 7.36 at week 14, rebounded to a peak of 10.04, then declined to 5.65 at week 44. High-risk prostate cancer visits showed less fluctuation but were still down by nearly a third, according to the investigators. Mean visits per day declined from 6.31 at week 10 to 5.24 at week 13, rebounded to a peak of 6.45, then dropped to 4.31 at week 41.
“For urologists and genitourinary cancer patients, early detection and treatment are critical to successful outcomes,” David F. Penson, MD, MPH, chair of the AUA Science and Quality Council, stated in a news release from Verana Health and the AUA. “Thanks to our collaboration with Verana Health, we now have a better understanding about changes in care due to the COVID-19 pandemic that we can study to gauge the long-term impact of delayed diagnoses and treatments for prostate cancer.”
The most surprising finding was the depth of the second decline in prostate cancer visits in October to early November after the initial drop in March and recovery in June, Dr Cooperberg told Renal & Urology News.
“Clearly as a country we have struggled to restore access to cancer care to pre-pandemic levels, even more so in the latter half of 2020 than in the first half,” he said. “We have multiple guidelines, developed in the past year, to help decide which patients’ cancer care can and cannot be safely deferred, but based largely on expert opinion. It will take time and attention to measure the impact of COVID-related delays on outcomes.”
Telehealth access needs to be uniform, he added. “Telehealth is very likely here to stay, and the regulatory reforms enacted in early 2020 to enable this – for example, suspension of inter-state practice prohibitions and re-interpretations of HIPAA – will hopefully be permanent.”
Dr Cooperberg noted that urologists can join AQUA, which now offers free standard membership, and contribute their data. “AQUA yields insights into the successes and challenges facing the specialty as a whole.”
Disclosure: This research was supported by Verana Health. Please see the original reference for a full list of disclosures.
References
Cooperberg MR, Brendel P, Lee DJ, et al. The national impact of the COVID-19 pandemic on U.S. prostate cancer community care. Presented at: ASCO 2021 virtual annual meeting held June 4-8. Poster 5061.
Steep decline in prostate cancer outpatient visits during the COVID-19 pandemic, according to research by Verana Health and American Urological Association [press release]. Verana Health; June 4, 2021.
