Brain tumours affect people of all ages and can be benign or malignant and require well-coordinated multi-specialist care. Brain tumours in children are especially associated with very high chance of cure and treatments have to be administered to ensure tumour control as well as minimal late toxicity, to maintain quality of life.
Like other cancer patients, brain tumour patients can be at an increased risk of COVID-19 infection due to their immunocompromised state caused by the tumour and treatments given to them.
Our team recently published a collaborative effort with modified recommendations as per available evidence for managing brain tumour patients optimally during the COVID-19 pandemic. Health care professional involved in management of brain tumour patients must take into cognisance the ongoing situation with limited resources and optimise treatment strategies along with prioritising patients based on disease severity. Here are some suggestions:
Virtual clinics
Adequate screening needs to be done in clinics to take care of brain tumour patients with suspected COVID-19 symptoms. Adequate usage of PPE and distancing should be encouraged. Visits of asymptomatic or mildly symptomatic patients and patients with benign tumours can be rescheduled to later date.
Virtual consultations on various digital platforms must be put in place to take care of brain tumour patients. Patients should be called for follow-up consultations only when they are symptomatic (moderate-tosevere headache, hemiplegia, incessant vomiting, and seizures).
Proper prioritisation
For patients requiring definitive treatment, their management can be discussed in virtual multi-disciplinary tumour boards (MDT) with only key decision making members. Surgical management should be planned judiciously during this time and should be done only for urgent cases, such as patients who have increased pressure (e.g., hydrocephalus) and require measures such as emergency shunt placement. Minimisation of hospitalisation and critical care stay should be encouraged to reduce burden on in-patient resources. Procedures where aerosol risk is high should be avoided and alternative approaches adopted. For brain tumour patient requiring radiation therapy, identifying and stratifying patients according to the priority of treatment can be done as follows:
- Malignant brain tumour patients can be considered for radiotherapy on high-priority basis.
- Radiotherapy in benign tumour and low-grade gliomas can be put on moderate to low priority.
- Radiation dosage using fewer sittings should be employed wherever applicable.
- All staff administering treatment should use appropriate PPE.
Similarly, brain tumour patients requiring chemotherapy should get priority based on their diagnosis (type and grade of brain tumour).
Emergency care
In case of intractable seizures that may be life threatening, the patient must be given intravenous anti-epileptics with due COVID-19 precaution. In case of seizures in COVID-19 patients, neurological symptoms due to COVID 19 should be considered as a rare possibility of acute necrotizing encephalopathy also needs to be kept in mind.
Compassionate Care
Health care professionals should be in touch with their brain tumour patients more frequently during this time of the pandemic through video and telephonic consultations and assure them of continued care and support even if they are unable to visit clinics.
Brain tumour patients may experience increased anxiety due to the fear emanating from the COVID-19 pandemic situation, hence adequate psychosocial support through virtual platforms should be provided to alleviate their concerns. Patients should be extremely careful and maintain adequate physical distancing and their diet and physical activities even during the lockdown restrictions.
( The author is Medical Director, Apollo Proton Cancer Centre )
