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Men’s Health Week: COVID-19 and treatment pathways

Consultant News

Men’s Health Week (15-21 June) has always played an important role in building awareness of male-specific conditions and diseases, but this year it will be focusing on COVID-19 – a virus that anyone can contract, although it seems to be disproportionately affecting men.

Mr Leye Ajayi is a Consultant Urological Surgeon at St John and St Elizabeth Hospital, specialising in prostate cancer and conditions of the urinary tract. The coronavirus outbreak has radically changed his workday, however, and he has seen first-hand the impact COVID-19 is having on patients.

He spoke to us about how the pandemic is hitting men harder, changing the treatment pathways for prostate cancer, and how lockdown is making men more attuned to their bodies and their wellbeing.

My day-to-day work has had to adapt to the pandemic. 

Before the pandemic, depending on what day of the week it was, I would do the rounds of the ward in the morning to see patients, and then operate in the afternoon or evening. That would be a normal working day. As a result of the coronavirus, however, elective surgeries were suspended as Private Hospitals are working in collaboration with NHS England to ensure there was sufficient access to health care for COVID-19 patients.

We felt a bit helpless as a surgical body, so at my teaching hospital – the Royal Free in London – we set ourselves up as SWAT: The Surgical Workforce and Assessment Team. As teams, all the surgeons go into the ITU to help with proning and de-proning COVID patients, which means turning them every 18 hours to prevent build-up of fluid in the lungs. We were also responsible for looking after tracheostomies, putting in central lines, changing urethral catheters, covering the nurses during their breaks and transferring ITU ventilated patients to radiology for their scans and generally doing everything we can to support the COVID response.

Men are more at risk from COVID-19 than women.

Working in my NHS Trust Intensive Therapy Unit, I’ve noticed that the virus is significantly more prevalent among men than women. A report released by Public Health England last week shows that male sex is a known factor associated with COVID-19-related mortality. Data from the Intensive Care National Audit and Research Centre (ICNARC) has shown that COVID-19 admissions to critical care are mostly among men, making up 71.0% of admissions reported as of 21 May. Meanwhile, the Office of National Statistics has reports that the age-standardised mortality rate for men with COVID-19 is significantly higher than that for women.

As a urologist, we are investigating people differently as a result of the pandemic. 

A lot of our cancer pathway for men’s health has changed the way we investigate our NHS patients during the pandemic. For example, most hospitals normally offer a rapid-access, one-stop prostate assessment for men. The patient will come in, have an MRI scan and a biopsy on the same day.

As a result of the pandemic, we’re having to deal with patients on the telephone rather than with face-to-face consultations. We talk to them on the phone at home, get a good clinical history and learn about their background and risk factors for prostate cancer. If appropriate – and the patient doesn’t need to shield due to any of the risk factors – then they come into hospital for an MRI scan.

Hospitals are being very clever now. For example, rather than the patient coming to reception, they just wait in their car until it’s their turn, and when called they come straight in from their car to the MRI scanner. After that, it’s straight back to their car to wait for their results. That MRI is fast-tracked and reported immediately, and if it’s decided that they need a biopsy, they can then come upstairs for it straightaway. It’s really a patient-centred pathway whereby you’re trying to avoid patients coming into contact with the hospital as much as possible.

We don’t want to miss patients who have clinically significant prostate cancer.

Initially, people were told to ‘stay at home, Protect the NHS, save Lives’. Now the mantra has changed, so we need to make sure that during that period we have not compromised the cancer care of our patients. As a result, doctors in Hospitals have come up with innovative methods in each hospital to make sure we do not lose our most high-risk patients as a result of that messaging.

Men are listening more closely to their bodies during lockdown than previously.

The pandemic seems to have heightened everybody’s awareness of self examination, self assessment – essentially paying attention to your body for symptoms.

Men in particular, who may have put their heads in the sand previously and perhaps ignored symptoms, are now much more attentive. So, as a result, patients are coming forward in an effort to try and reduce their risk of developing prostate-related diseases in particular. For example, in my practice I’ve picked up four testicular cancers in the last four weeks. That’s one a week, which is not common.

Often testicular cancer is not a cancer that you present with symptoms, it’s by self-examination, and these men have obviously examined themselves. So, I feel, and hope that the COVID-19 pandemic has improved general self-awareness.

People being more aware of their health could help fight COVID-19.

We all have a responsibility in this situation – to be more aware of and astute with our bodies, to be vigilant in our hand hygiene, our self hygiene and our general awareness of others. There is always a silver lining, and in this case it’s that people are paying much more attention to their health than they have been previously. Now that lockdown has relaxed, we want to encourage our patients to come in for health checkups.


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