Work

The impact of the COVID-19 pandemic on treatment patterns in glioblastoma

Year: 2023

Type: article

Abstract: The coronavirus disease 2019 (COVID-19) pandemic and subsequent public shutdowns led to significant disruptions to medical care in 2020, with 94% of neuro-oncology practitioners reporting changes to clinical practice.1,2 Prior studies have shown that there was significant care disruption (including delays and cancelations) for cases diagnosed with cancer.3 Unlike many other cancer types, our prior work suggests that there was little disruption in the new diagnosis of glioblastoma (unpublished data). Disruptions in various aspects of brain tumor management due to the COVID-19 pandemic have also been previously documented by survey studies,4 but analysis of retrospective data has been limited. Here, we utilized a database containing >85% of new primary brain tumor diagnoses5 to assess the effect of the pandemic on treatment patterns for glioblastoma in the United States. IDHwt glioblastoma (ICD-O-3 code 9440 and Brain Molecular Marker site-specific data item #3816 value of 5) cases were retrieved from the National Cancer Database, a project of the Commission on Cancer, for cases 40+ years of age diagnosed from 2018 to 2020. Logistic regression was used to generate odds ratios, 95% confidence intervals, and P values of receiving resection, chemotherapy, or radiation after diagnosis for cases diagnosed in 2020 and 2018 as compared to 2019, after adjustment for potential confounders found to be significantly associated with treatment receipt, including age, sex, race/ethnicity, insurance type, average zip code household income, residential distance from facility, comorbidity score, facility type, region, and MGMT promoter methylation. Among individuals who received treatment and treatment time was known, logistic regression was used to estimate the odds of delayed time to treatment (>7 days for first surgery, >45 days for radiation, and >45 days for chemotherapy), adjusted for confounders. This cutoff was set at the 75th percentile of each time variable in the 2018–2019 period, representing a clinically significant delay in treatment. As a sensitivity analysis, we repeated analyses using only 2020 cases with a recorded COVID-19 test at an academic center (presumed to have earlier testing capability and indicative of diagnosis during the pandemic) compared to 2019.

Source: Neuro-Oncology

DOI: 10.1093/neuonc/noad234