Urgent considerations for the neuro-oncologic treatment of patients with gliomas during the COVID-19 pandemic

Abstract

<jats:title>Abstract</jats:title> <jats:p>The COVID-19 outbreak is posing unprecedented risks and challenges for all communities and health care systems, worldwide. There are unique considerations for many adult patients with gliomas who are vulnerable to the novel coronavirus due to older age and immunosuppression. As patients with terminal illnesses, they present ethical challenges for centers that may need to ration access to ventilator care due to insufficient critical care capacity. It is urgent for the neuro-oncology community to develop a proactive and coordinated approach to the care of adults with gliomas in order to provide them with the best possible oncologic care while also reducing their risk of viral infection during times of potential health care system failure. In this article, we present an approach developed by an international multidisciplinary group to optimize the care of adults with gliomas during this pandemic. We recommend measures to promote strict physical distancing and minimize exposures for patients, address risk and benefit of all therapeutic interventions, proactively develop end-of-life plans, educate patients and caregivers, and ensure the health of the multidisciplinary neuro-oncology workforce. This pandemic is already changing neuro-oncologic care delivery around the globe. It is important to highlight opportunities to maximize the benefit and minimize the risk of glioma management during this pandemic and potentially, in the future.</jats:p>

Impact of the Coronavirus (COVID-19) pandemic on surgical practice - Part 2 (surgical prioritisation)

“…Patients who do not exhibit any signs of life-, limb-or vision-threatening conditions should have appointments deferred for 3-6 months and regularly monitored. If possible, patients should be seen via tele-consultations whenever possible, and all relevant members of the multidisciplinary neurosurgical teams should be present to avoid miscommunication regarding treatment plans due to extra communication steps [62].…”

“…Young adult patients with high grade malignant glioma should undergo maximal safe glioma resection; carmustine (BCNU) wafer may be used safely with no risks of contamination. Radiological investigations alone should be used to generate treatment plans for the elderly and for patients with comorbidities [62]. For low grade glioma patients, the BNOS suggests a delay of 3-6 months [65].…”

Involuntary ambulatory triage during the COVID-19 pandemic – A neurosurgical perspective

“…[10] During times of unprecedented strain on our healthcare system, an attempt to balance the acuity of medical needs with available resources is of overarching importance. [8,11] It is noteworthy that none of the cases primarily postponed as elective surgical interventions re-presented as emergencies during the course of the lockdown period. This circumstance merits the early and careful consideration put into the delimiting of non-elective surgical interventions.…”

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic

“…This change from not offering maximal surgical resection for a tumor with clear effects of edema and compression is a remarkable departure from our traditional practice. Our decision-making shares similarities with the neuro-oncologic community consensus at this time for the treatment of gliomas, in that diagnostic surgery and adjuvant therapy can be delayed if the patient is stable and if further tumor expansion will not hinder complete resection later on [11].…”