CovidNeuroOnc: A UK multicenter, prospective cohort study of the impact of the COVID-19 pandemic on the neuro-oncology service

Abstract

Background The COVID-19 pandemic has profoundly affected cancer services. Our objective was to determine the effect of the COVID-19 pandemic on decision making and the resulting outcomes for patients with newly diagnosed or recurrent intracranial tumours. Methods We performed a multi-centre prospective study of all adult patients discussed in weekly neuro-oncology and skull base multidisciplinary team meetings who had a newly diagnosed or recurrent intracranial (excluding pituitary) tumour between 01 April and 31 May 2020. All patients had at least 30-day follow-up data. Descriptive statistical reporting was used. Results There were 1357 referrals for newly diagnosed or recurrent intracranial tumours across fifteen neuro-oncology centres. Of centres with all intracranial tumours, a change in initial management was reported in 8.6% of cases (n=104/1210). Decisions to change the management plan reduced over time from a peak of 19% referrals at the start of the study to 0% by the end of the study period. Changes in management were reported in 16% (n=75/466) of cases previously recommended for surgery and 28% of cases previously recommended for chemotherapy (n=20/72). The reported SARS-CoV-2 infection rate was similar in surgical and non-surgical patients (2.6% vs. 2.4%, p>0.9). Conclusions Disruption to neuro-oncology services in the UK caused by the COVID-19 pandemic was most marked in the first month, affecting all diagnoses. Patients considered for chemotherapy were most affected. In those recommended surgical treatment this was successfully completed. Longer-term outcome data will evaluate oncological treatments received by these patients and overall survival.

The impact of the COVID-19 pandemic on the number of brain tumor surgeries in Poland: A national database study

“…The scale of changes in treatment plans decreased after the initial months of the pandemic. 19,21 In addition, our observations showed a marked decrease in the general trends in the number of patients and subgroups. These numbers most probably represent new diagnoses in patients who experienced an extended time to diagnosis and start of treatment.…”

How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology?

“…(37) Another centre reported that glioblastoma cases were more aggressive than the previous year, with simple diagnostic biopsy often being management of choice. (29) Some centres described altered treatment pathways, for example, opting for either RT alone or in combination with surgery, (27) or cancelling operations and offering purely supportive care when benefit from active treatment was considered limited. (28) Additionally, one study found that disruptions to care were greater in centres without a dedicated surgical oncology list.…”

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“…In affected patients, haematological toxicity may lead to additional hospital admissions for treatment, further aggrandising infection risk. (60) Such concerns are reflected in a UK study, where 20% of HGG patients were offered supportive care instead of chemotherapy (27). ASCO-endorsed guidelines indicate the continued use of temozolomide for MGMT-hypermethylated gliomas, with risk mitigation strategies including reduced steroid dosing and close monitoring of neutrophil and lymphocyte counts (53).…”

Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines

“… 2 These patients have tumors that increase in size and cause mass effect if there are delays in neurosurgical management and adjuvant therapy. 3 Thus, there is a need to determine adequate precautions for operating on these patients and giving timely adjuvant therapy despite the pandemic.…”