Article Text
Abstract
Objectives Pressures 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.
Design A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020.
Setting Regional neurosurgical units outside London (as the pandemic was more advanced at time of study).
Participants Representatives 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 measures Primary 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.
Results 18 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.
Conclusion COVID-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 registration This 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/).
- neurological oncology
- change management
- infectious diseases
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Footnotes
Twitter @Sjp58Price, @LeedsNeuro, @surashsurash
Collaborators COVID-CNSMDT Study Group: Nicola Johnson, Yasir Chowdhury, Mandy Lynch, George Malcolm, Ven Iyer, Constantinos Charalambides, Chris Herbert, Richard Mair, Thomas Santarius, Fiona P Harris, Olivia Poulter, Sandeep Solanki, Kismet Hossain-Ibrahim, Paul Brennan, Shailendra Achawal, Gerry O’Reilly, John Goodden, Simon Thomson, Andrew R Brodbelt, Emmanuel Chavredakis, David DA Lawson, Jibril Farah,Tina Karabatsou Syed Shumon, Damian Holliman, Muhammed Zafar, William Sage, Murugan Sitaraman, Yahia Al-Tamimi, Paul Grundy, Ebere Ogbonnaya.
Contributors SJP, MDJ, PP, CW and PH were involved in the study concept and design. SJP, TF, VW, GC, NUB, FTA, AS, MTP, CR, RKM, MDJ, DMF, SS, SSu, GS, RJP, OR, HWC and EA were involved in collecting data from each site and guarantee the data at each site. SJP and AJ were involved in data analysis. HB provided the patient perspective on our findings. SJP wrote the first draft of the paper and all authors were involved in revising the paper and have approved the final paper.
Funding SJP is funded by a National Institute for Health Research (NIHR), (Career Development Fellowship).This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. AJJ is funded by the NIHR Brain Injury MedTech Co-operative.MTCP is supported by Cancer Research UK Brain Tumour Centre of Excellence Award (C157/A27589).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethical approval was not required as no patient-specific information was collected.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data access queries should be addressed to the corresponding author (SJP). All data is anonymised and individual unit level data is not available. Approval for data release will be made by SJP, MDJ, PP and PH who conceived the study.