Clinical Scorecard: Effects of the COVID-19 Pandemic on the Management of Patients with Metastatic Uro-Oncological Conditions Receiving Systemic Cancer Treatment: A Multicenter Analysis in German University Hospitals

At a Glance

Key Highlights

• COVID-19 pandemic caused delays in systemic cancer treatment and follow-up imaging for metastatic uro-oncological patients.
• Patients with metastatic uro-oncological diseases are at increased risk of severe COVID-19 due to immunosuppression and comorbidities.
• German university hospitals maintained oncologic care during the first COVID-19 wave, but treatment delays and deviations from guidelines were observed.

Guideline-Based Recommendations

Diagnosis

• Baseline radiologic restaging should be performed before initiating systemic treatment to establish oncological status.
• Use Eastern Cooperative Oncology Group (ECOG) performance status to assess patient functional status.

Management

• Systemic anti-cancer therapies (chemotherapy, immuno-oncologic treatments including checkpoint inhibitors, androgen deprivation therapy) should be continued with minimal delays.
• Implement special hygienic measures and consider telemedicine to reduce infection risk.
• Balance risks of treatment delays against risks of severe COVID-19 infection in immunosuppressed patients.

Monitoring & Follow-up

• Follow-up imaging and clinical assessments should adhere to standard intervals as per German and European urological guidelines.
• Monitor for delays exceeding 2 weeks in therapy or restaging and assess impact on prognosis.
• Track SARS-CoV-2 infection status and influenza status during treatment.

Risks

• Delays in systemic treatment may lead to disease progression and worse outcomes.
• Immunosuppression from cancer and treatments increases susceptibility to severe COVID-19 infection.
• Healthcare system overload may limit access to timely oncologic care.

Patient & Prescribing Data

162 metastatic uro-oncological patients aged 33–89 years (median 68.5), predominantly male (87.6%), mostly with ECOG 0–1 performance status.

Systemic therapies included chemotherapy, immuno-oncologic treatments (checkpoint inhibitors), and androgen deprivation therapy; treatment delays and deviations from standard care timelines were documented during the first COVID-19 wave.

Clinical Best Practices

• Ensure baseline oncological assessment before pandemic-related disruptions.
• Maintain systemic cancer treatment schedules as closely as possible to avoid undertreatment.
• Apply rigorous infection control measures to protect vulnerable uro-oncological patients.
• Use telemedicine and video consultations to reduce hospital visits when feasible.
• Closely monitor for treatment delays and adjust care plans accordingly.
• Prioritize care for elderly, multimorbid, and immunosuppressed patients at higher risk.

References

• Robert Koch Institute COVID-19 Data
• German Society for Urology (DGU) Guidelines
• European Association of Urology (EAU) Guidelines