Abstract
BACKGROUND
Immunosuppressive treatment increases COVID-19 risk. Neuro-oncology patients may not qualify for ITU if they deteriorate, but without oncological treatment, prognosis is poor. The pandemic has seen the introduction of new guidelines; including alternative treatment schedules which balance risks of contracting COVID-19, against safely delivering effective cancer treatment. We assess COVID-19 impact on neuro-oncology treatment at Guy’s Cancer Centre, London.
METHODS
Notes of patients seen March-April 2020 were reviewed. Demographic data, tumour grade, treatment and changes due to COVID-19 recorded.
RESULTS
111 patients were identified (69 male: 42 female, median age 51years). 65 were WHO Grade 4, 24 Grade 3, 17 Grade 2, 2 Grade 1, 1 metastatic-neuroblastoma, 1 anaplastic-medulloblastoma and 1 radiological diagnosis of high-grade-glioma. 14% (32) of consultations were in person (16 new, 7 consents, 9 attending for treatment); 86% (198) were telephone. 8 had concurrent chemo-radiotherapy, 22 radiotherapy alone, 64 chemotherapy alone, 15 had active-surveillance and 2 best-supportive-care. To minimise COVID-19 risk, 22.5% (25) had treatment altered: - A 76-year-old had a radiological diagnosis; - 4 had hypofractionated radiotherapy (30Gy in 6#) to minimise hospital visits; - 7 had no chemotherapy (5 were unmethylated /age, 2 patient choice); - 4 switched from PCV to Lomustine; - 11 stopped chemotherapy early; - 50% (36) were given prophylactic GCS-F; - No patients were recruited for trials. 19 reported possible COVID-19 symptoms – 7 had delays and 3 stopped treatment. 4 tested COVID-19 positive (although not all tested). 1 died of COVID-19 (off treatment). Review of March-April 2020 service showed similar new patient referrals compared to the same time in 2019 (16 and 19 respectively).
CONCLUSION
Despite concern about decreasing new referrals during the pandemic, this wasn’t the case for our service. 77.5% of patients had no treatment changes due to COVID-19 and all 22 patients on trial were able to continue treatment throughout this period.