The Impact of the COVID-19 Pandemic and Lockdown on the Outcome of Glioblastoma

Abstract

Background Rapid spread of the SARS-CoV-2 pandemic in 2020 led to an indirect effect on non-COVID patients. Since neuro-oncology cases are unique and brain tumors need a specific therapeutic protocol at proper doses and at the right times, the effects of the pandemic on health care services for patients with glioblastomas (GBs) and their impact on overall survival (OS) and quality of life are not yet known.

Methods We conducted a retrospective study of 142 GB patients who underwent surgery, radiation, and chemotherapy before and after the lockdown period, aiming to determine the differences in access to care, treatment modality, and adjuvant therapies, and how the lockdown changed the prognosis.

Results The number of procedures performed for GB during the pandemic was comparable to that of the prepandemic period, and patients received standard care. There was a significant difference in the volume of lesions measured at diagnosis with a decreased number of “accidental” diagnoses and expression of a reduced use by the patient for a checkup or follow-up examinations. Patients expressed a significantly lower performance index in the lockdown period with longer progression-free survival (PFS) in the face of a comparable mean time to OS.

Conclusion Patients treated surgically for GB during the pandemic period had a more pronounced and earlier reduction in performance status than patients treated during the same period the year before. This appears to be primarily due to lower levels of care in the rehabilitation centers and more frequent discontinuation of adjuvant care.

Keywords

neurosurgery - COVID-19 - SARS-CoV-2 - glioblastoma

Availability of Data and Material

The study does not have repository data. Data are available in an institutional database that can be purchase from the corresponding author (DA).

Ethical Approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent to Participate

Informed consent was obtained from all individual participants included in the study. The patients consented to the submission of this review article to the journal.

Author Contributions

D.A. were responsible for conceptualization, writing, statistical analysis, and surgical operation. L.D.'A. contributed to conceptualization and surgical operation. R.D.P. and G.C. contributed to data analysis, draft, and radiotherapy data. TJ contributed to follow-up data and research. FR contributed to research, writing, and data collection. D.G. and A.F. supervised the study. FM contributed to radiotherapy management and data collection. AS contributed to supervision and surgical operation.

Publication History

Received: 21 March 2023

Accepted: 24 October 2023

Article published online:
03 July 2024

• References

• 1 Johns Hopkins University Coronavirus Resource Center. 2020 . Accessed November 3, 2023 at: https://coronavirus.jhu.edu/map.html
• 2 Amoo M, Horan J, Gilmartin B. et al. The provision of neuro-oncology and glioma neurosurgery during the SARS-CoV-2 pandemic: a single national tertiary centre experience. Ir J Med Sci 2021; 190 (03) 905-911
• 3 Bernhardt D, Wick W, Weiss SE. et al. Neuro-oncology management during the COVID-19 pandemic with a focus on WHO grades III and IV gliomas. Neuro-oncol 2020; 22 (07) 928-935
• 4 Verity R, Okell LC, Dorigatti I. et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 2020; 20 (06) 669-677
• 5 Society of British Neurological Surgeons. Adult Neuro- oncology service provision during COVID-19 outbreak. 2020. Accessed September 4, 2020 at: https://www.sbns.org.uk/index.php/policies-and-publications/covid/
• 6 Pesce A, Palmieri M, Armocida D, Frati A, Santoro A. Letter: neurosurgery and coronavirus (COVID-19) epidemic: doing our part. Neurosurgery 2020; 87 (01) E48-E49 [Internet]
• 7 Armocida D, Frati A, Salvati M, Santoro A, Pesce A. Is Ki-67 index overexpression in IDH wild type glioblastoma a predictor of shorter progression free survival? A clinical and molecular analytic investigation. Clin Neurol Neurosurg 2020; 198: 106126
• 8 Azab MA, Azzam AY. Impact of COVID-19 pandemic on the management of glioma patients around the world. An evidence-based review. Brain Disord 2021; 2: 100012
• 9 Armocida D, Pesce A, Di Giammarco F, Frati A, Santoro A, Salvati M. Long term survival in patients suffering from glio-blastoma multiforme: a single-center observational cohort study. Diagnostics (Basel) 2019; 9 (04) 209
• 10 Armocida D, Palmieri M, Frati A, Santoro A, Pesce A. How SARS-CoV-2 can involve the central nervous system. A systematic analysis of literature of the department of human neurosciences of Sapienza University, Italy. J Clin Neurosci 2020; 79: 231-236
• 11 Paglia F, Caporlingua A, Armocida D, Rizzo F, Santoro A, D'angelo L. Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: a free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery. Neurocirugia (Astur Engl Ed) 2022; 33 (05) 219-226
• 12 Armocida D, Pesce A, Santoro A, Salvati M, Frati A. Letter to the editor: “The neurosurgical perspective for the 2021 WHO classification of tumors of the central nervous system: a missed opportunity?”. World Neurosurg 2021; 155: 203-204
• 13 Hameed NUF, Ma Y, Zhen Z. et al. Impact of a pandemic on surgical neuro-oncology-maintaining functionality in the early phase of crisis. BMC Surg 2021; 21 (01) 40
• 14 COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; 107 (09) 1097-1103
• 15 Pesce A, Armocida D, Paglia F. et al. IDH wild-type glioblastoma presenting with seizure: clinical specificity, and oncologic and surgical outcomes. J Neurol Surg A Cent Eur Neurosurg 2022; 83 (04) 351-360
• 16 Armocida D, Pesce A, Frati A, Santoro A, Salvati M. EGFR amplification is a real independent prognostic impact factor between young adults and adults over 45yo with wild-type glioblastoma?. J Neurooncol 2020; 146 (02) 275-284
• 17 Lozano-Sanchez F, Ursu R, Di-Stefano AL. et al. Descriptive and retrospective analysis of diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the pandemic. Neurooncol Adv 2021; 3 (01) vdab078
• 18 Boele FW, Butler S, Nicklin E, Bulbeck H, Pointon L, Short SC, Murray L. Communication in the context of glioblastoma treatment: a qualitative study of what matters most to patients, caregivers and health care professionals. Palliat Med 2023; 37 (06) 834-843
• 19 Ramakrishna R, Zadeh G, Sheehan JP, Aghi MK. Inpatient and outpatient case prioritization for patients with neuro-oncologic disease amid the COVID-19 pandemic: general guidance for neuro-oncology practitioners from the AANS/CNS Tumor Section and Society for Neuro-Oncology. J Neurooncol 2020; 147 (03) 525-529
• 20 Bloch O, Han SJ, Cha S. et al. Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg 2012; 117 (06) 1032-1038
• 21 National Health Service (NHS). Specialty guides for patient management during the coronavirus pandemic: clinical guide for the management of cancer patients during the coronavirus pandemic. 2020. Accessed September 4, 2020 at: https://www.uhb.nhs.uk/coronavirus-staff/downloads/pdf/CoronavirusCancerManagement.pdf
• 22 Chidley P, Shanker M, Phillips C. et al. Moderately hypofractionated versus conventionally fractionated radiation therapy with temozolomide for young and fit patients with glioblastoma: an institutional experience and meta-analysis of literature. J Neurooncol 2022; 160 (02) 361-374
• 23 Wen PY, Packer RJ. The 2021 WHO classification of tumors of the central nervous system: clinical implications. Neuro-oncol 2021; 23 (08) 1215-1217