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ESMO Patient Guides COVID19 1000x250

Outpatient visits

High priority

Your outpatient appointment may be a high priority if:

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    You have muscle invasive urothelial bladder cancer and you need an appointment to find out if you are suitable for potentially curative treatment
  • You are experiencing new signs and symptoms of advanced urothelial bladder cancer, but have not previously been diagnosed with advanced disease
  • You are receiving treatment with first-line immunotherapy but your cancer is progressing quickly
  • You need an appointment to investigate symptoms of a suspected cancer-related emergency, such as brain metastases or spinal cord compression

Medium priority

Your outpatient appointment may be a medium priority if:

  • You are already receiving treatment for urothelial bladder cancer and need outpatient appointments to monitor your response to treatment
  • You have previously received chemotherapy and are due to attend outpatient appointments as part of your post-chemotherapy follow-up schedule
  • You have high/intermediate-grade or recurrent/refractory non-muscle invasive disease and need an appointment to start treatment with bacillus Calmette-Guérin (BCG) or to discuss a possible cystectomy

Low priority

Your outpatient appointment may be a low priority if:

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    You are not currently experiencing any symptoms from your cancer, have no evidence of metastatic disease, and the purpose of your appointment is a routine follow-up visit. In these cases, appointments may be conducted via telephone
  • You have low-risk non-muscle invasive urothelial bladder cancer

Imaging

High priority

Your appointment may be a high priority if:

  • You have locally advanced or metastatic disease and need imaging to stage your cancer in order to determine the best treatment plan for you
  • You need imaging to re-stage your cancer during or after neoadjuvant chemotherapy
  • You need imaging to investigate an urgent cancer-related issue, such as bleeding, a bone fracture or a serious side effect of treatment
  • You need imaging because your doctor thinks you might be experiencing a relapse or that you have metastatic disease

Medium priority

Your appointment may be a medium priority if:

  • You are undergoing treatment and you are scheduled to have imaging to assess your response to therapy

Low priority

Your appointment may be a low priority if:

  • You are not currently experiencing any symptoms from your cancer and the purpose of your appointment is a routine follow-up imaging test. In these cases, imaging may be delayed
  • You are scheduled to have imaging to investigate non-muscle invasive disease

Surgery

High priority

Your appointment may be a high priority if:

  • You are scheduled to undergo bladder resection and a biopsy to confirm a diagnosis of advanced urothelial bladder cancer
  • You are scheduled to undergo a cystectomy. Cystectomy should preferably take place in a designated non-COVID-19 hospital. In some cases, cystectomy may be delayed by using neoadjuvant chemotherapy. Non-urgent cystectomy (e.g. for non-muscle invasive disease) may be delayed until the peak of the COVID-19 pandemic has passed. Your doctor will discuss the potential benefit of cystectomy versus the risk of COVID‑19 infection and will advise on the best approach for you

High/medium priority

Your appointment may be a high/medium priority if:

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    You are scheduled to undergo a cystoscopy to investigate haematuria that has been detected by a laboratory test, but is not visible in the urine

Additional considerations for the surgical management of urothelial bladder cancer

  • Radiotherapy should not be considered as a preferred alternative to surgery during the COVID-19 pandemic

Medical management of muscle-invasive urothelial bladder cancer

High priority

Your appointment may be a high priority if:

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    You are scheduled to receive neoadjuvant chemotherapy to shrink your cancer or to delay a cystectomy
  • You have cancer that has spread to your lymph nodes and are scheduled to receive chemotherapy
  • You are scheduled to receive chemotherapy to control symptoms of your cancer

High/medium priority

Your appointment may be a high/medium priority if:

  • You are scheduled to receive adjuvant chemotherapy

Low priority

Your appointment may be a low priority if:

  • You are scheduled to receive adjuvant radiotherapy

Medical management of advanced urothelial bladder cancer

High priority

Your appointment may be a high priority if:

  • You are scheduled to receive first-line treatment for metastatic disease. In these cases, immunotherapy may be preferable to chemotherapy. If you receive immunotherapy, your doctor may consider increasing the interval between your treatment visits to reduce the number of hospital visits
  • You are scheduled to undergo palliative radiotherapy to treat severe haematuria or spinal cord compression, and surgery is not possible

Medium priority

Your appointment may be a medium priority if:

  • You are scheduled to receive first-line treatment for low-burden disease, but are not currently experiencing any symptoms
  • You are scheduled to undergo palliative radiotherapy to relieve bone pain, or for other palliative reasons

Low priority

Your appointment may be a low priority if:

  • You have already received four cycles of palliative chemotherapy after a confirmed response to treatment, and are scheduled to continue receiving palliative chemotherapy
  • You did not previously respond to treatment with platinum-based chemotherapy and are scheduled to receive further chemotherapy

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