Impact of COVID-19 pandemic on surgical neuro-oncology multi-disciplinary team decision making: a national survey (COVID-CNSMDT Study)

Abstract

ObjectivesPressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making.DesignA prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020.SettingRegional neurosurgical units outside London (as the pandemic was more advanced at time of study).ParticipantsRepresentatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19.Primary and secondary outcome measuresPrimary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK.Results18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed—the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%–28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected.ConclusionCOVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments—most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures.Study registrationThis study was registered with the Royal College of Surgeons of England’s COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).

SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

“…Clinical trial enrollment was also affected as 18.6% of patients lost the ability to participate due to COVID-19 [ 157 ]. In the United Kingdom, 10.7% of patients had to change their management plans with 86% no longer undergoing surgery [ 158 ]. These delays are two-sided as hospital resources were needed to treat COVID-19 patients, and these individuals are considered high-risk.…”

Impact of COVID‐19 lockdown measures on oncological surgical activity: Analysis of the surgical pathology caseload of a tertiary referral hospital in Northwestern Italy

“…Multiple studies have investigated the impact of COVID‐19 pandemic on both oncological and nononcological activities with variable findings 2–7 . We thus wanted to define the real ability in preserving the oncological surgical practice at our Institution during the most critical months of the epidemic by analyzing the surgical pathology activity of our units.…”

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

“…Multiple neuro-oncology guidelines from high-volume centers in HICs have recommended the following: symptom-based and disease-based patient triaging; patient segregation based on COVID-19 status; PPE based on World Health Organization recommendations with emphasis on PAPR for level III; limiting aerosolizing procedures in the OR; use of negative-pressure ORs for COVID-19–positive patients; use of negative-pressure ICUs for postoperative patients (in case these patients develop COVID-19 infection); immediate postoperative step-down areas; the use of telemedicine for outpatient consults; the use of hypofractionated RT; and the use of less toxic chemotherapy protocols in managing neuro-oncology patients. 1 , 2 , 6 , 7 , 8 , 9 , 10 , 11 , 31 , 32 , 33 , 34 Our review has shown that the experience and practice patterns reported in LMICs were generally similar to these recommendations but had some differences attributed to resource availability and patient preferences.…”