INTRODUCTION
The Coronavirus Disease-2019 (COVID19) pandemic has led to radical shifts in the delivery of healthcare. To minimize the risk of person-to-person transmission, particularly in the nosocomial setting, attempts have been made to increase utilization of telehealth(1). Yet, many aspects of healthcare require in-person interactions. This is particularly true for urologic oncology patients as chemotherapy infusions, radiation therapy, surgical expatriation, and radiologic surveillance are components of routine care. Furthermore, the time-sensitive nature of malignancy makes delays in care problematic for many patients.
To this end, several collaborative reviews have been published on strategies for the appropriate triage of patients with urologic malignancy during the COVID19 pandemic(2-4). These recommendations are largely based on the existing literature regarding the natural history of individual urologic malignancies. For highly aggressive malignancies such as muscle invasive bladder cancer, significant delays in care are clearly unacceptable(5). Similarly, for those malignancies with a more indolent behavior such as low-risk prostate cancer, delays and modifications to routine care are unlikely to produce significant adverse outcomes(6). However, for moderately aggressive malignancies such as intermediate-risk and high-risk prostate cancer, non-muscle invasive bladder cancer, and most kidney cancers, the risks and benefits of delaying and modifying care should be based both on the natural history of the cancer, and the natural history of COVID-19 in these patients and cancer patients in general.
Indeed, several large population-based studies from various countries have suggested malignancy is associated with adverse outcomes in COVID19 patients(7-9). Furthermore, studies from cancer centers and cancer consortiums have evaluated the natural history of COVID19 in larger cohorts of cancer patients and found a mortality rate ranging from 12%-28%(10-12). Interestingly, malignancy type did not appear to be a significant predictor of mortality. However, a notable limitation of the existing literature is that many studies utilized small cohorts of cancer patients or did not have a control group of patients without a cancer diagnosis. Furthermore, though our understanding of COVID19 and cancer has continued to evolve, little is known about the impact of cancer history on the risk of developing acute kidney injury (AKI) in COVID19 patients. AKI occurs in an estimated 4.5-8.9% of COVID19 cases(13, 14). AKI increases the risk of developing CKD(15), which is concerning for cancer patients as many oncologic therapies may result in renal impairment(16). Additionally, in patients with genitourinary malignancies, CKD has been associated with adverse post-operative outcomes(17-19).
Our academic medical system includes several hospitals and outpatient clinics throughout the New York City area, which has been one of the world’s most afflicted locations and in turn has treated a large population of COVID19 patients. Accordingly, in the present study, we seek to evaluate COVID19 patients treated within our academic medical system to determine if history of malignancy, both in general and specifically in genitourinary oncology patients, is associated with clinical outcomes, including AKI and mortality.