COVID-19 impact on urology and other viral concerns
The lessons we have learnt during COVID-19, including its impact on urological care, as well as urological research; and a call to action in the elimination of HPV-related cancers are some of the topics that were covered today at EAU22 Plenary Session 2. Experts Dr. Oscar Brouwer (NL) and Prof. Florian Wagenlehner (DE), chaired this highly informative session.
Prof. Chris Chapple’s (GB) presentation, “The COVID-19 pandemic and its impact on urological care: What lessons have we learnt?” looked at the adaptation that was required as the global pandemic rapidly unfolded and progressed.
“Data suggests we are only just starting to see the effects on the impact of COVID-19. Unlike acute pathologies, such as stroke and myocardial infarction, the true excess mortality due to COVID-19 related disruption to cancer pathways will not be fully evident for 10 years or longer.”
This medical crisis did expediate academic and clinical solutions, and according to Prof. Chapple, the EAU was very reactive to COVID-19 with new treatment guidelines, and online education. It was of vital importance to update many aspects of urology practice, from patient consultation to the triage of urologic surgeries in order to ensure the safety of their patients and staff.
It has been estimated that only 50% of the decision-making was in the hands of clinics, which gives an indication to the impact on urological practice and delivery of care in relation to allocation of resources, care for severely unwell patients, aligning patient needs with family, and balancing physical and mental health needs of workers. The psychological impact has been widely studied on nurses and doctors, as well as those in medical training.
In his presentation “Large simple trials after the COVID-19 pandemic: Lessons learnt for urology research”, Prof. Kari Tikkinen (FI) discussed the need for better evidence-based research.
“There have been thousands of randomised controlled trials (RCTs) for COVID-19 treatment, but the majority were small and single centre, with 83% unpublished. The risk of small studies is very big, we need really large samples and a lot of evidence. This is the most ethical way to get the best results.”
Prof. Tikkinen highlighted two large studies as examples – the British RECOVERY trial, and the WHO’s SOLIDARITY trial.
The RECOVERY trial had strong national support, a pre-existing UK clinical-trials network, streamlined trial conduct and data collection, as well as a strong letter of support from the Chief Medical Officers. The WHO SOLIDARITY trial is another good example whereby multi-country involvement allowed recruitment to shift with disease incidence. These studies both had simple selection criteria, simple patient-important outcomes, consent, simple randomisation and data collection, it was possible to do alongside intense clinical work, careful study design and ethical evaluation.
Prof. Tikkinen’s take home message was “Trials need to be as large as possible, as simple as possible, practical with minimal trouble, and deliver patient important outcomes.”
We have the tools to eliminate HPV
Prof. Daniel Kelly (BE), Co-Chair of the European Cancer Organisation HPV Action Network, delivered his pre-recorded lecture on “Eliminating HPV-related cancers: A call to action”.
“HPV is largely preventable, yet it is the fourth most common cancer is some areas of Europe. We need to all be involved and urologists have a role to play in HPV prevention, not just in dealing with the consequences.”
The European Union’s Beating Cancer Plan has committed to dedicate funds under the EU4Health programme and other funding instruments to support member states’ efforts to extend routine vaccination against HPV for girls and boys, in order to eliminate cervical cancer and other cancers caused by HPV. The objective is to vaccinate at least 90% of the EU target population of girls, and to significantly increase the vaccination of boys by 2030. Prof. Kelly noted that this should not replace screening though.
“In our ongoing three-year action plan we have mapped existing vaccination and cervical cancer screening policies and programmes across the WHO European region, and now we are supporting national HPV advocacy campaigns in the countries that are falling behind. We are going to target Eastern European countries for vaccination and screening as these numbers are very low.”
“The challenge is to involve young people and actively work together to identify what causes hesitancies around vaccination and reduce to stigma around HPV.”
Prof. Kelly stated that further research is needed to establish if there is any association between prostate cancer and HPV. “If there is a connection, it does support the idea of a gender neutral vaccination programme in the future”.
Access and/or rewatch these presentations and other lectures in full via the On Demand feature of the EAU22 Virtual Platform.