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

The COVID-19 pandemic reduced delays in the care pathway for patients with glioma at a French institute

CONTEXT

Delays in cancer management have been reported during the COVID-19 pandemic. Neuro-oncology patients represent a real challenge as their disease can progress rapidly without appropriate care. However, data available for these patients over this period is scarce.

OBJECTIVE

Therefore, the aim of this study was to examine the impact of the COVID-19 pandemic on therapeutic care within a specific population at a French institute. A retrospective descriptive study was conducted using electronic medical records. All patients who underwent surgery for glioma in a neurosurgery unit between January 1st, 2019 and December 31st, 2020 were included.

RESULTS

A total of 114 patients were operated for a glioma; 70 patients in 2019 (before the pandemic) and 44 in 2020 (during the pandemic). Among these patients, 89% were diagnosed with a high-grade glioma, including 81% with glioblastoma. The mean time between first symptoms and imaging process increased from 35days in 2019 to 40days in 2020. However, in the subsequent steps of the care pathway, timelines improved at each stage with a reduction up to four days. The time reduction was statistically significant for two specific stages of care: (i) the interval between the surgery and the histomolecular diagnosis, with a reduction of two days, and (ii) the period between the histomoleculardiagnosis and the consultation for results announcement, with a reduction of three days. In summary, on average, the first treatment was initiated 49 days post-surgery in 2019 and 36days post-surgery in 2020.

CONCLUSION

This study showed that the COVID-19 outbreak positively impacted the therapeutic care pathway of patients with glioma at a French institute. Although the improvement can be measured in days, this acceleration of care was nonetheless crucial for the population studied.

Impact of the SARS-CoV-2/COVID-19 pandemic on the patient journeys of those with a newly diagnosed paediatric brain tumour in the UK: a qualitative study

OBJECTIVES

To explore the impact of the SARS-CoV-2/COVID-19 pandemic on the diagnosis, management and patient journey for children and young people with a newly diagnosed brain tumour in the UK.

DESIGN

Exploratory qualitative study focused on patient journeys from multiple perspectives, conducted as part of a wider mixed-methods study.

SETTING

Three paediatric oncology tertiary centres in the UK.

PARTICIPANTS

10 children and young people with brain tumours (n=6 females, n=4 males), 20 caregivers (n=16 females, n=4 males) and 16 stakeholders (specialist nurses, consultant neurosurgeons and oncologists, and representatives from brain tumour charities) were interviewed between January 2022 and June 2023.

RESULTS

The paper incorporates multiple perspectives, including those of children and young people, parents/caregivers, clinical staff and charity representatives, to explore the patient journey. Five themes describe the journey for new patients with paediatric brain tumour during the pandemic, focusing on (1) challenges getting into the healthcare system, (2) managing as a family during restrictions imposed by the pandemic, (3) complexities of building a cohesive and supportive healthcare team, (4) difficulties caregivers experienced in accessing practical and emotional support in hospital and (5) ongoing difficulties experienced by families in the community.

CONCLUSIONS

Findings from this study offer practical insights from children, parents/caregivers and relevant stakeholders to improve the healthcare system during future disruptions. Overall, this study not only sheds light on the challenges faced by families during the pandemic but also provides suggestions for improving healthcare services to ensure a more comprehensive and effective response in times of crisis.

Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns

Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6 kg∙capita-1∙year-1. However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month-1∙truckload-1) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.

Neurosurgical care for patients with high-grade gliomas during the coronavirus disease 2019 pandemic: Analysis of routine billing data of a German nationwide hospital network

Background

Little is known about delivery of neurosurgical care, complication rate and outcome of patients with high-grade glioma (HGG) during the coronavirus disease 2019 (Covid-19) pandemic.

Methods

This observational, retrospective cohort study analyzed routine administrative data of all patients admitted for neurosurgical treatment of an HGG within the Helios Hospital network in Germany. Data of the Covid-19 pandemic (March 1, 2020-May 31, 2022) were compared to the pre-pandemic period (January 1, 2016-February 29, 2020). Frequency of treatment and outcome (in-hospital mortality, length of hospital stay [LOHS], time in intensive care unit [TICU] and ventilation outside the operating room [OR]) were separately analyzed for patients with microsurgical resection (MR) or stereotactic biopsy (STBx).

Results

A total of 1763 patients underwent MR of an HGG (648 patients during the Covid-19 pandemic; 1115 patients in the pre-pandemic period). 513 patients underwent STBx (182 [pandemic]; 331 patients [pre-pandemic]). No significant differences were found for treatment frequency (MR: 2.95 patients/week [Covid-19 pandemic] vs. 3.04 patients/week [pre-pandemic], IRR 0.98, 95% CI: 0.89-1.07; STBx (1.82 [Covid-19 pandemic] vs. 1.86 [pre-pandemic], IRR 0.96, 95% CI: 0.80-1.16, P > .05). Rates of in-hospital mortality, infection, postoperative hemorrhage, cerebral ischemia and ventilation outside the OR were similar in both periods. Overall LOHS was significantly shorter for patients with MR and STBx during the Covid-19 pandemic.

Conclusions

The Covid-19 pandemic did not affect the frequency of neurosurgical treatment of patients with an HGG based on data of a large nationwide hospital network in Germany. LOHS was significantly shorter but quality of neurosurgical care and outcome was not altered during the Covid-19 pandemic.

Non-COVID-19 UK clinical trials and the COVID-19 pandemic: impact, challenges and possible solutions

INTRODUCTION

The COVID-19 pandemic impacted the operationalisation of non-COVID-19 clinical trials globally, particularly site and participant recruitment and trial success/stoppage. Trials which anticipate recruitment challenges may embed methods such as the QuinteT Recruitment Intervention (QRI) to help identify and understand the sources of challenges. Such interventions can help shed light on pandemic-related challenges. This paper reports our experience of the impact of the COVID-19 pandemic on conducting clinical trials with an embedded QRI, highlighting how the QRI aided in identifying challenges and potential solutions, particularly related to the site set-up and participant recruitment.

MAIN BODY

We report on 13 UK clinical trials which included a QRI. Information is from QRI data and researchers' experience and reflections. In most trials, recruitment was lower than even the lowest anticipated rates. The flexibility of the QRI facilitated rapid data collection to understand and document, and in some instances respond to, operational challenges. Challenges were mostly logistical, pandemic-related and beyond the control of the site or central trial teams. Specifically: disrupted and variable site opening timelines -often due to local research and development (R&D) delays- shortages of staff to recruit patients; fewer eligible patients or limited access to patients; and intervention-related factors. Almost all trials were affected by pandemic-related staffing issues including redeployment, prioritisation of COVID-19 care and research, and COVID-19-related staff illness and absence. Trials of elective procedures were particularly impacted by the pandemic, which caused changes to care/recruitment pathways, deprioritisation of services, reduced clinical and surgical capacity and longer waiting lists. Attempted solutions included extra engagement with staff and R&D departments, trial protocol changes (primarily moving online) and seeking additional resourcing.

CONCLUSION

We have highlighted wide-ranging, extensive and consistent pandemic-related challenges faced by UK clinical trials, which the QRI helped to identify and, in some cases, address. Many challenges were insurmountable at individual trials or trials unit level. This overview highlights the need to streamline trial regulatory processes, address staffing crises, improve recognition of NHS research staff and for clearer, more nuanced central guidance on the prioritisation of studies and how to deal with the backlog. Pre-emptively embedding qualitative work and stakeholder consultation into trials with anticipated difficulties, moving some processes online, and flexible trial protocols may improve the resilience of trials in the current challenging context.

Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature

PURPOSE

Shorter hypofractionated radiation therapy (HF-RT) schedules may have radiobiological, patient convenience and healthcare resource advantages over conventionally fractionated radiation therapy (CF-RT) in glioblastoma (GBM). We report outcomes of young, fit GBM patients treated with HF-RT and CF-RT during the COVID-19 pandemic, and a meta-analysis of HF-RT literature in this patient subgroup.

METHODS

Hospital records of patients with IDH-wildtype GBM treated with HF-RT (50 Gy/20 fractions) and CF-RT (60 Gy/30 fractions) between January 2020 and September 2021 were reviewed. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Univariable analysis was performed using Cox regression analysis. A systematic search and meta-analysis of studies from January 2000 to January 2022 was performed.

RESULTS

41 patients were treated (HF-RT:15, CF-RT:26). For both HF-RT and CF-RT groups, median age was 58 years and 80-90% were ECOG 0-1. There were more methylated tumours in the HF-RT group. All patients received concurrent/adjuvant temozolomide. At 19.2 months median follow-up, median OS was 19.8 months and not-reached for HF-RT and CF-RT (p = 0.5), and median PFS was 7.7 and 5.8 months, respectively (p = 0.8). HF-RT or CF-RT did not influence OS/PFS on univariable analysis. Grade 3 radionecrosis rate was 6.7% and 7.7%, respectively. 15 of 1135 studies screened from a systematic search were eligible for meta-analysis. For studies involving temozolomide, pooled median OS and PFS with HF-RT were 17.5 and 9.9 months (927 and 862 patients). Studies using shortened HF-RT schedules reported 0-2% Grade 3 radionecrosis rates.

CONCLUSION

HF-RT may offer equivalent outcomes and reduce treatment burden compared to CF-RT in young, fit GBM patients.