Wang Tina, Liu Sariah, Joseph Thomas, Lyou Yung
Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA.
J Clin Med. 2020 May 22;9(5):1574. doi: 10.3390/jcm9051574.
The recent novel coronavirus, named coronavirus disease 2019 (COVID-19), has developed into an international pandemic affecting millions of individuals with hundreds of thousands of deaths worldwide. The highly infectious nature and widespread prevalence of this disease create a new set of obstacles for the bladder cancer community in both delivering and receiving care. In this manuscript, we address the unique issues regarding treatment prioritization for the patient with bladder cancer and how we at City of Hope have adjusted our clinical practices using a team-based approach that utilizes shared decision making with all stakeholders (physicians, patients, caregivers) to optimize outcomes during this difficult time. In addition to taking standard precautions for minimizing COVID-19 risk of exposure for those entering a healthcare facility (screening all personnel upon entry and donning facemasks at all times), we suggest the following three measures: (1) delay post-treatment surveillance visits until there is a decrease in local COVID-19 cases, (2) continue curative intent treatments for localized bladder cancer with COVID-19 precautions (i.e., choosing gemcitabine/cisplatin (GC) over dose-dense methotrexate, vinblastine, doxorubicin, cisplatin (ddMVAC) neoadjuvant chemotherapy), and (3) increase the off-treatment period between cycles of palliative systemic therapy in metastatic urothelial carcinoma patients.
最近出现的新型冠状病毒，即2019冠状病毒病（COVID-19），已演变成一场国际大流行，影响了数百万人，全球有数十万人死亡。这种疾病的高传染性和广泛流行给膀胱癌患者群体在接受治疗和提供护理方面带来了一系列新的障碍。在本手稿中，我们讨论了膀胱癌患者治疗优先级的独特问题，以及希望之城医院如何采用团队协作方法调整我们的临床实践，该方法利用与所有利益相关者（医生、患者、护理人员）共同决策，以在这段艰难时期优化治疗结果。除了采取标准预防措施以尽量降低进入医疗机构人员感染COVID-19的风险（对所有进入人员进行筛查并要求始终佩戴口罩）外，我们建议采取以下三项措施：（1）推迟治疗后的监测随访，直到当地COVID-19病例减少；（2）在采取COVID-19预防措施的情况下，继续对局限性膀胱癌进行根治性治疗（即选择吉西他滨/顺铂（GC）而非剂量密集型甲氨蝶呤、长春花碱、阿霉素、顺铂（ddMVAC）新辅助化疗）；（3）延长转移性尿路上皮癌患者姑息性全身治疗周期之间的非治疗期。
