A: Here are some active ways to help your loved ones:
- Remind them of the basic safety steps: washing hands, disinfecting surfaces and social distancing.
- Help and encourage them to avoid situations with potential exposure. This can mean asking them to not go out to stores or public areas where people tend to gather. For you, help them by going shopping and other activities outside the house or arrange these services online for deliveries.
- See what other needs can be met with technology regarding online platforms such as YouTube and social media options. Other possibilities to consider are: setting video appointments with a healthcare provider, video time with family and friends and showing them virtual entertainment options. Many cultural organisations, such as museums and musical organisations are doing free online events. This is not only helping them but you as well, as it may teach them new skills and help everyone involved with feelings of isolation and depression.
A: Coming to a hospital to receive BCG immunotherapy could put patients at risk for catching the COVID-19 infection. If a patient has had four doses of induction, it is possible to wait a few weeks before receiving the remaining doses of BCG. The risk of COVID-19 transmission when coming to the hospital for BCG instillations is higher than any risk of delaying dose five and six for several weeks.
If a patient is on maintenance therapy, it is likely that delaying BCG is much less risky than the risk of contracting COVID-19.
High-risk patients should be treated within 6 weeks of scheduled BCG immunotherapy, BCG treatment to low and intermediate-risk patients can wait for 6 months.
A: The current consensus on this issue suggests the systematic performance of a SARS-CoV-2 detection test by reverse transcriptase polymerase chain reaction (RT-PCR) in nasopharyngeal sample to all oncologic patients before surgery, given the higher risk of postoperative lung complications in COVID-19 positive patients. In case of unavailability of the test, a chest computed tomography (CT) could be an alternative. This fact raises the need to guarantee the absence of infection in patients in order to protect healthcare workers.
A: In case of instillation therapy (any) and COVID-19 infection, stop instillation therapy until the patient is without symptoms and recovered in order to decrease the risk of complications and the risk to transmit the disease. Restart (how many instillations and schedule) depends on the time the instillations have been stopped (at least one year in BCG treatment) and how many instillations the patient already had.
A: Early post-operative instillation of chemotherapy in presumably low or intermediate-risk tumours it is a low priority during the COVID-19 pandemic.
We know that the oncological benefit of a single postoperative instillation of Mitomycin C has been especially demonstrated in low risk patients (score EORTC recurrence score <5). It should be emphasised that if we proceed to a TURBT there is no demonstrated increased risk of infection of COVID-19 to proceed with the instillation during the first 24h after TURBT, before discharging the patient.
A: Intravesical BCG or chemotherapy instillations in patients with intermediate-risk NMIBC: low priority, defer by 6 months, if the situation of the COVID-19 pandemic is locally still high risk. It has been mentioned that BCG might induce sustained immunity, protect against infections and decrease severity of an infection to a certain extent.
Intravesical instillations of Mitomycin C have demonstrated to reduce recurrence rate in intermediate non-muscle invasive bladder cancer. Moreover, short intensive (3-4 months) regimens are equally effective than regimens of one year.
In the situation of high prevalence of the disease it is better to minimise the number of instillations or to stop, since it does not influence progression of the disease and cancer specific survival. The risk of COVID-19 infection has to be balanced against the benefit of 35% reduction in a 1-year recurrence rate.