Bladder Cancer Detection During the COVID-19 Pandemic

Bladder Cancer Detection During the COVID-19 Pandemic: The Benefits of Telemedicine & In-Home Sampling

The onset of the COVID-19 pandemic in early 2020 prompted physical distancing and stay-at-home requirements that have had a far-reaching impact on cancer care. Many countries have experienced significant delays in cancer detection, due to reduced or suspended screening programs, reduced diagnostic services, and reluctance of patients to seek in-person healthcare. 

It is of major concern that pandemic-related detection delays will result in patients being diagnosed with cancers at more advanced stages that are more difficult to treat. In this article we describe how the increased use of telemedicine and in-home sampling/testing can help patients avoid potentially harmful delays in cancer diagnosis and treatment.

Delayed cancer detection during the COVID-19 pandemic

In the United States screening rates for breast, prostate, and colorectal cancer plummeted at the start of the pandemic (i.e., during March–May 2020). Although monthly screening rates had somewhat recovered by July 2020, large deficits remained at the end of the year.

• In the first 7 months of 2020 compared with the same period in 2019, 3.9 million fewer women were screened for breast cancer, 1.6 million fewer men were screened for prostate cancer, and 3.8 million fewer men and women were screened for colorectal cancer.¹

The US National Cancer Institute has estimated that the delayed detection and treatment of breast and colorectal cancers during the pandemic will result in 10,000 excess deaths in the United States over the next 10 years.² Of further note, this estimation may be somewhat optimistic as it is based on an assumed 6-month period of disruption, which in hindsight has been considerably longer.

An additional US study that compared the number of patients newly diagnosed with any of 8 cancer types during pandemic and pre-pandemic time periods observed significant declines in mean monthly rates during March–May 2020 (30% lower than pre-pandemic) and November 2020–March 2021 (19% lower).³ These findings suggest that many more cancers remain undiagnosed.

Delayed detection of bladder cancers

Older adults have a higher risk of severe COVID-19 outcomes, so in this age group there has been considerable hesitancy to seek treatment for other medical concerns during the pandemic. As the average age at bladder cancer diagnosis is 73 years,⁴ it is correspondingly likely that many individuals currently have undetected bladder cancer.

The pandemic also appears to be adversely affecting the outcomes of patients previously diagnosed with bladder cancer. For instance, a study carried out in Europe during June–September 2020 in patients previously treated for non-muscle invasive bladder cancer found that delays of >3 months in follow-up cystoscopy were associated with a 7-fold increase in the probability of cancer progression.⁵

Delays in cancer screening and diagnosis during the COVID-19 pandemic demonstrate that alternative approaches are needed to identify cancers early. Telemedicine and in-home testing are strategies that offer many advantages in terms of convenience, efficiency, and safety. Here we discuss how these strategies can be used to ensure the timely diagnosis and treatment of cancer.

What are telemedicine and in-home testing?

Telemedicine refers to the use of technology to deliver medical care from a distance: a doctor (or other healthcare provider) in one location uses telecommunications to deliver care to patients in distant locations. The terms ‘telemedicine’ and ‘telehealth’ are often used interchangeably. However, strictly speaking, telehealth has a broader meaning that also encompasses non-clinical health-related services (e.g., health education; wearable monitoring devices that record and transmit measurements; smart-phone enabled diagnostic tests).

Some of the technologies commonly used in telemedicine and telehealth include telephone calls, SMS text messaging, email and secure web-based messaging systems (e.g., WhatsApp, iMessage), web-based video conferencing platforms (e.g., Zoom, Skype, FaceTime), digital photography, smart phone mobile health (mHealth) apps, and remote patient monitoring devices.

In-home sampling and testing systems are also forms of remote healthcare:

• In-home sampling systems enable samples to be collected at home; the collected samples are then sent to a laboratory for analysis, and results are usually provided electronically.
• In-home testing systems enable the complete sampling and testing process to be carried out at home, commonly providing results in under an hour (for example, urine-based pregnancy tests).

Changes in medical care prompted by the pandemic: the transition to telemedicine

During 2020, a transition to greater use of telemedicine took place in many countries worldwide, in oncology practices and across healthcare services in general. Through the use of telephone calls, video calls and other virtual interactions, patient care could continue without the infection risk of in-person visits.

Before the COVID-19 pandemic, reimbursement guidelines were a significant barrier to telemedicine, and uptake across the United States was low. However, when the US Centers for Medicare and Medicaid Services introduced support in March 2020, the transition to telemedicine visits was rapid, with data indicating a 154% increase in telemedicine visits during the last week of March 2020 compared with the same period during 2019.⁶

Changes in medical care prompted by the pandemic: in-home testing and sampling

In addition to driving the uptake of telemedicine, social distancing requirements during the pandemic have also increased interest in at-home sampling/testing systems. A diverse range of at-home tests is currently available, for purposes that include disease screening, disease diagnosis, monitoring response to treatment, and assessing wellness (e.g., measuring hormone or nutrient levels).

More specifically, the pandemic has highlighted the usefulness of in-home sampling/testing options for cancer screening and diagnosis. For example, several US health plans have introduced or expanded the use of in-home stool-based sampling systems for colon cancer screening, and home sampling kits for cervical cancer screening are being evaluated. Urinary biomarker tests for bladder cancer, such as Cxbladder, have also come to the forefront. Cxbladder is a non-invasive genomic urine test that accurately detects the presence or absence of bladder cancer and provides the option of an in-home sampling system.

Benefits of telemedicine and in-home cancer testing

As a complement to traditional in-person care, telemedicine and in-home cancer testing offer several benefits, including:

• Safety – patients who have increased vulnerability to infectious disease (e.g., patients undergoing chemotherapy treatment) can avoid the relatively high-risk setting of medical centres/hospitals.
• Convenience – doctors are able to provide care in the comfort of the patient’s home.
• Efficiency – saves time and money spent travelling to and from appointments.
• Appointments and tests can often be more readily arranged at short notice.
• A family member or support person who lives distantly can be easily included in a virtual telemedicine visit.

An analysis of monthly telehealth use in the United States from April 2019 to March 2021 showed that visits peaked during March 2020 at approximately 12 million. Although by March 2021 visits had decreased to around 9 million per month, this is still considerably higher than pre-pandemic levels of around 1 million visits.⁷ Medical practices are still offering telemedicine visits and other telehealth services such as in-home cancer testing, both for patient convenience and to provide a socially distanced healthcare option.

It is widely considered that telehealth and in-home testing will continue to play a prominent role in healthcare now and into the future, growing and evolving with the development of new technologies and tests to ultimately provide a more patient-centred model of care.

Telemedicine, in-home testing and early cancer detection

Many types of cancer are largely treatable if detected at early stages; conversely, delays in diagnosis often have a detrimental impact on patient outcomes. If you’re overdue for a cancer screening appointment or have noticed any symptoms of concern, it is essential to contact your healthcare provider.

If you don't feel comfortable going for an in-person clinic visit, a telemedicine appointment may be possible. You can also enquire about the availability of in-home sampling and testing, as there may be an in-home option that is suitable for your needs. In-home sampling/testing systems can provide non-invasive, reliable detection of early-stage cancers, including bladder cancer.

Cxbladder is a genomic urine test for bladder cancer that comes with the option of in-home sampling

Cxbladder is a suite of easy-to-use and non-invasive tests designed to help rule out urothelial bladder cancer in patients experiencing blood in urine (hematuria), the most common symptom of the disease, and to monitor for recurrent disease in those who have been treated for non-muscle invasive bladder cancer. 

Cxbladder delivers exceptional performance and meaningful results. To simplify and streamline the bladder cancer testing process, we are now offering  Cxbladder in-home sampling for patients in the US. Participating patients have the option of submitting their urine sample in the comfort of their own home.
Learn more about Cxbladder     Learn more about Cxbladder in-home sampling

General Sources

• American Academy of Family Physicians. What’s the difference between telemedicine and telehealth? Accessed October 25, 2021.
• American Cancer Society. Survival Rates for Bladder Cancer. Accessed October 25, 2021.
• Broom A, Kenny K, Page A, et al. The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts. Clin Cancer Res. 2020;26:5809-5813.
• Healio Primary Care. From COVID-19 to colorectal cancer, telehealth has changed how we look at preventive care. Accessed October 25, 2021.
• Jaklevic MC. Pandemic Spotlights In-home Colon Cancer Screening Tests. JAMA. 2021;325:116-118.
• Lab Tests Online. At-Home Tests: What You Need to Know. Accessed October 25, 2021.
• NEJM Catalyst. What is Telehealth? Accessed October 25, 2021.
• Ng K, Vinnakota K, Sharma A, et al. Urinary biomarkers to mitigate diagnostic delay in bladder cancer during the COVID-19 era. Nat Rev Urol. 2021;18:185-187.
• Richards M, Anderson M, Carter P, et al. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020;1:565-567.

References

1. Chen RC, Haynes K, Du S, Barron J, Katz AJ. Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic. JAMA Oncol. 2021;7:878-884.
2. American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.
3. Kaufman HW, Chen Z, Niles JK, Fesko YA. Changes in Newly Identified Cancer Among US Patients From Before COVID-19 Through the First Full Year of the Pandemic. JAMA Netw Open. 2021;4:e2125681.
4. American Cancer Society. Key Statistics for Bladder Cancer. Accessed October 14, 2021.
5. Culpan M, Keser F, Acar HC, et al. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract. 2021;75:e14490.
6. Koonin LM, Hoots B, Tsang CA, et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic – United States, January-March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595-1599.
7. Trilliant Heatlh. 2021 Trends Shaping the Post-Pandemic Health Economy. Accessed October 25, 2021.