• Wallis Christopher J D CJD Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: wallis.cjd@gmail.com., Catto James W F JWF Academic Urology Unit, University of Sheffield, Sheffield, UK., Antonio Finelli, Adam W Glaser, John L Gore, Stacy Loeb, Todd M Morgan, Alicia K Morgans, Nicolas Mottet, Richard Neal, Tim O'Brien, Anobel Y Odisho, Thomas Powles, Ted A Skolarus, Angela B Smith, Bernadett Szabados, Zachary Klaassen, and Daniel E Spratt.
• Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: wallis.cjd@gmail.com.
• Eur. Urol. 2020 Nov 1; 78 (5): 731-742.

ContextThe coronavirus disease 2019 (COVID-19) pandemic necessitated rapid changes in medical practice. Many of these changes may add value to care, creating opportunities going forward.ObjectiveTo provide an evidence-informed, expert-derived review of genitourinary cancer care moving forward following the initial COVID-19 pandemic.Evidence AcquisitionA collaborative narrative review was conducted using literature published through May 2020 (PubMed), which comprised three main topics: reduced in-person interactions arguing for increasing virtual and image-based care, optimisation of the delivery of care, and the effect of COVID-19 in health care facilities on decision-making by patients and their families.Evidence SynthesisPatterns of care will evolve following the COVID-19 pandemic. Telemedicine, virtual care, and telemonitoring will increase and could offer broader access to multidisciplinary expertise without increasing costs. Comprehensive and integrative telehealth solutions will be necessary, and should consider patients' mental health and access differences due to socioeconomic status. Investigations and treatments will need to maximise efficiency and minimise health care interactions. Solutions such as one stop clinics, day case surgery, hypofractionated radiotherapy, and oral or less frequent drug dosing will be preferred. The pandemic necessitated a triage of those patients whose treatment should be expedited, delayed, or avoided, and may persist with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in circulation. Patients whose demographic characteristics are at the highest risk of complications from COVID-19 may re-evaluate the benefit of intervention for less aggressive cancers. Clinical research will need to accommodate virtual care and trial participation. Research dissemination and medical education will increasingly utilise virtual platforms, limiting in-person professional engagement; ensure data dissemination; and aim to enhance patient engagement.ConclusionsThe COVID-19 pandemic will have lasting effects on the delivery of health care. These changes offer opportunities to improve access, delivery, and the value of care for patients with genitourinary cancers but raise concerns that physicians and health administrators must consider in order to ensure equitable access to care.Patient SummaryThe coronavirus disease 2019 (COVID-19) pandemic has dramatically changed the care provided to many patients with genitourinary cancers. This has necessitated a transition to telemedicine, changes in threshold or delays in many treatments, and an opportunity to reimagine patient care to maintain safety and improve value moving forward.Copyright © 2020 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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