Abstract
ObjectivesPressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making.DesignA prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020.SettingRegional neurosurgical units outside London (as the pandemic was more advanced at time of study).ParticipantsRepresentatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19.Primary and secondary outcome measuresPrimary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK.Results18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed—the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%–28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected.ConclusionCOVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments—most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures.Study registrationThis study was registered with the Royal College of Surgeons of England’s COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).
Highlights
The COVID-19 pandemic has caused an unprecedented threat to healthcare delivery worldwide
►► Our data are based on 1221 patients. ►► Data collection occurs 2 weeks before and 2 weeks after the peak of COVID-19 infections. ►► We have not collected patient-level data so can’t assess what happens to individual patients. ►► We have only looked at surgical management and do not have data on oncology treatment
All new brain diagnoses are discussed in a multidisciplinary team (MDT) meeting that decides the optimal treatment for each patient
Summary
The COVID-19 pandemic has caused an unprecedented threat to healthcare delivery worldwide. Hospitals dealing with large numbers of patients requiring critical care have redeployed staff and converted operating rooms into intensive care units to cope with infected patients. This has had a marked impact on services and patient care for patients without COVID-19. Each MDT will review a range of tumours from non-m alignant or slow- growing (low-grade) tumours whose initial treatment could be safely deferred, to the malignant tumours that are characterised by rapid growth and patient deterioration without treatment in a matter of weeks. National guidelines recommended that surgery for malignant tumours should continue during the COVID-19 pandemic providing adjuvant oncology treatment is available.[3] The role of the MDT is critical to good patient management
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