Effects of Covid 19 on patients of Brain Tumour either diagnosed or under adjuvant therapy:
The COVID-19 pandemic has disrupted healthcare systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions.
As of May 12, 2021, according to WHO, the COVID-19 pandemic has affected 222 countries and territories, with more than 159 million cases and more than 3·3 million deaths reported. The COVID-19 pandemic has resulted in widespread mortality and has exposed the frailties of healthcare systems worldwide. National responses have varied by country, with restrictions or lockdowns of varying severity implemented to curb the pandemic, with different outcomes.
On Jan 30, 2020, the first case of COVID-19 was reported in India, and as of May 12, 2021, according to WHO, almost 23 million people had been infected. In response to the pandemic, the Government of India instituted a series of nationwide Impact of COVID-19 on cancer care in India: a cohort study-up lockdown that began on March 24, 2020, with severe restrictions imposed on inter-state and intra-state travel. Data from cancer centres across the world have shown that the provision of oncology services has been considerably reduced during the COVID pandemic.
It has been seen in a study published in Lancet that Between March 1st to May 31, 2020 –
Overall, two-thirds of the surveyed countries had included maintenance of health-care services for non-communicable diseases in their COVID-19 preparedness plans; however, substantial disparities were identified between high-income countries and low-income and middle-income countries (72% vs 42%). This lack of preparedness could have a detrimental long-term impact on the outcomes of patients with cancer, especially in resource-poor countries.
In this background, some pertinent questions and topics arise regarding the effects of Covid 19 on Brain tumour which needs to be addressed and these are discussed below :
A. Covid Appropriate Behaviour that should be followed by Brain Tumour patients:
B. Stage wise guidance for brain tumour treatment during COVID-19 pandemic:
COVID19 has not changed the management protocol of brain tumours yet. If this continues, there might be some guidelines pouring in from large bodies like ASTRO/ESTRO/ASCO for brain tumour patients as well.
Traditionally brain tumours are not staged in a classical manner like other cancers. Brain tumours are classified either as benign or malignant. Malignant tumours are again divided as per their pathological grades into high grade or low grade and so on.
In some centres, radiosurgery instead of surgical removal of tumour is being done to reduce hospital stay. However, radiosurgery is not “magic treatment” for all brain tumours. It can be done only for some very selective conditions like AVM (arteriovenous malformation), pituitary adenoma, craniopharyngioma, a small limited number of metastatic lesions, meningioma, schwannoma etc.
C. Postponing treatment of brain tumour and how long?
Any tumour, which is immediately life-threatening or can cause rapid neurological deterioration or aggressive behaviour (like a glioblastoma) should be treated immediately with surgery, radiation, chemotherapy, or different combinations of them as per indication. It is advisable that patients discuss with an experienced doctor in this field.
D. Risk of postponing treatment and continue treatment in this pandemic:
Risk of continuing treatment:
Risk of withholding treatment:
At the end, it is to be remembered that, the effect between treatment, overall treatment time and expected benefits are all interlinked in a complex manner which varies in between patients and tumours. To suggest an idealistic and holistic approach in this crucial time should be the job of treating physician.
E. Priorities of Primary Brain Tumours:
1. Priorities for OPD Visit :
2. Priorities for Neurosurgery:
F. Neurological Effects of Covid 19:
All brain tumour patients will have to spend considerable exposure to hospital and because of the disease, chemotherapy, radiotherapy and other medications will be immunocompromised and vulnerable to covid 19 infections and their complications. So, they should be vaccinated at the earliest.