Survey Indicates Urgent Need For COVID-19 Testing in Vulnerable Patients With Kidney Cancer

Only a small percentage of patients with kidney cancer who are considered to be particularly vulnerable to COVID-19 have actually been tested for infection, according to results from a recent survey conducted by the charity Kidney Cancer UK.

Results from the survey, which was conducted from April 20 to 28, 2020, indicated that just 4 of 95 patients surveyed had undergone testing for the virus, and 50% reported having been informed that they are “extremely vulnerable” to infection. Moreover, 41% of patients with kidney cancer reported feeling anxious or very anxious with regard to COVID-19.

The anxiety that patients felt about the virus was comparable to the anxiety that participants felt about their kidney cancer in light of the pandemic. Specifically, 40% of patients shared that they felt anxious or very anxious about their cancer during this time, and 40% considered themselves to be at high risk for contracting COVID-19. Thirty-two percent of those surveyed felt that they fell into this subgroup were but they were never notified that they were at increased risk for infection; this indicates that some patients remain unclear regarding whether they are extremely vulnerable during this time.

Notably, the majority of patients who had been informed that they fell into the extremely vulnerable subgroup were notified of this information via either letter (35%) or text (10%); only 8% were informed via telephone, which limits their opportunity to discuss any concerns that they might have with their healthcare provider.

“Patients are anxious, and their treatment has often been interrupted, including delays in surgery,” Thomas Powles MBBS, MRCP, MD, a professor of genitourinary oncology and director of Bart’s Cancer Centre, stated in a press release. “Many have switched to telephone consultations and only 4 in 95 have been offered a COVID-19 test. Many patients [with kidney cancer] have not been informed well about their risk to the disease and their risk level needs to be communicated clearer.”

Increased communication between patients and their providers is imperative, as these conversations can help inform individualized treatment decisions during the pandemic. Notably, the survey results suggested that patients receiving systemic therapy for their kidney cancer were relatively well informed. Specifically, 17% of patients said that they would not pause their systemic treatment in light of the pandemic versus 5% who said they would; 9% of patients reported having had already paused their treatment. Ten percent of patients reported that they were unsure of whether they would pause therapy. Moreover, of the patients who were receiving infusions, 14% reported that they would not be willing to skip an infusion compared with 3% who said they would; 10% reported having already paused these infusions.

Additionally, patients were also asked whether they would still want scans done if their treatment had been paused and 58% reported that they would. These results suggest that the majority of the patients who are on systemic therapy understand what their options look like in light of the pandemic and are communicating with their health care providers to manage their care during this time, according to Kidney Cancer UK.

In addition to treatment modifications and potential pauses that have been implemented to reduce the risk of infection, the question of whether to delay surgery has been a topic of serious debate. As a result, the uptake for surgery in kidney cancer has been greatly impacted. Of the survey participants who have been waiting for a date for surgery, 44% said they would still undergo the procedure versus 16% who said they would not and 40% who said they were not sure. However, only 4% of participants reported having had a surgery cancelled in light of the pandemic.

Lastly, survey results suggested that patients may still be unclear on the risks versus the benefits of some of the aspects of their care, which might be impacting their willingness to attend appointments that have been made with their providers. Although 56% of patients said that they would continue to attend their appointments, 19% have had their appointments paused, 17% said that they might continue appointments, and 4% said that they wouldn’t continue attending appointments during the pandemic.

In response to the pandemic, a major universal effort has been made within the healthcare space to provide strong alternatives to face-to-face appointments and thus, help reduce patients’ risk of exposure to the virus. To this end, the majority of cancer centers have implemented measures such as telemedicine (66%) and video consultations (3%), according to the survey participants. However, 19% of those surveyed claimed that they had not yet been offered an alternative by their health team.

“This is an important survey which has geographical representation of kidney cancer patients throughout the UK,” said Maxine Tran, MBBS, BSc, MRCS, FRCS, PhD, senior lecturer in renal cancer surgery and honorary consultant urological surgeon at The Royal Free London in the press release. “For me, there are 3 key messages: first, although patients are concerned about COVID-19 they are equally anxious about their cancers; second, despite this concern, only 16 % would not have surgery if offered for their cancer, and third, the majority of patients would still attend for their scans and clinic appointments in this current climate. These are strong indicators that provide critical insight into health priorities as defined by patients and highlight that urgent cancer care must continue, despite the challenges of COVID-19.”

With 96% of the those surveyed claiming to have not yet been tested for COVID-19, there is a clear need for improved communication to convey the risks posed to patients with kidney cancer, as well as their options for treatment during the pandemic. While patients undergoing systemic therapy appear to be relatively well informed, there is still a need for additional support to ensure that patients are provided with the best care possible during this time.

Reference

The impact of COVID-19 on kidney cancer patients. Kidney Cancer UK News. News release. Kidney Cancer UK News. April 16, 2020. Accessed July 2, 2020. bit.ly/325DzRw.