|Year : 2020 | Volume
| Issue : 1 | Page : 1-2
Glioma patients facing COVID-19 pandemic
Department of Neurosurgery/Neuro-Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, Guangdong Province, China
|Date of Submission||30-Mar-2020|
|Date of Acceptance||31-Mar-2020|
|Date of Web Publication||13-Apr-2020|
Prof. Zhong-ping Chen
Department of Neurosurgery/NeuroOncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chen Zp. Glioma patients facing COVID-19 pandemic. Glioma 2020;3:1-2
Since the beginning of 2020, the coronavirus disease known as COVID-19 has rapidly spread and become a global pandemic affecting millions of people. For patients with gliomas, the COVID-19 pandemic has brought even greater challenges to an already difficult treatment process. COVID-19 not only causes severe acute respiratory syndrome but also triggers multiple organ dysfunction, leading to higher mortality, especially in patients with other underlying comorbidities. Patients with cancer such as gliomas have a suppressed immune system due to malignancy and anticancer treatment and are thus more susceptible to infection and have poorer prognosis than individuals without cancer. The COVID-19 pandemic has significantly altered hospital systems across the world, including medical resource supply chains and the need for resource reallocation. Currently, both patients with gliomas and medical doctors feel disorientated during such an unprecedented crisis. I have communicated with several experts engaged in glioma treatment in China, including neurosurgeons, radiation oncologists, and neuro-oncologists, and summarized some suggestions below.
Surgery is the first-line treatment for glioma. Thus, patients newly diagnosed with glioma during this pandemic should be treated with surgical resection, especially those with suspicion of higher-grade gliomas, since delay in surgery could reduce chance of treatment success. On the other hand, if the tumor is more likely to be a low-grade glioma and the patient is asymptomatic, postponing surgery until a safer time is a reasonable option. For scheduled glioma surgery, all patients in China should undergo routine presurgical evaluation and “COVID-19 screening,” which includes a chest computed tomographic scan and laboratory test for the novel coronavirus. Patients who are COVID-19 negative could be operated under routine precautions in low-risk regions. For patients who are COVID-19 positive, who require emergency surgery, or who are COVID-19 negative but come from a high-risk area, surgery must be performed under strict infection control precautions. In such circumstances, the surgical procedure must be performed in a tertiary healthcare facility.
Radiation therapy is not contraindicated for patients who are COVID-19 positive but do not have clinical symptoms. However, patients who are scheduled for radiation therapy must also receive “COVID-19 screening.” For patients with gliomas who are COVID-19 positive, irradiation should be delayed until they are fully recovered. All patients who have been confirmed COVID-19 negative should be provided with appropriate personal protective equipment when they are undergoing radiation therapy. Radiation therapy equipment should be disinfected after each individual treatment. The irradiation room must be completely cleaned up and sterilized every 2–3 h.
Glioma patients have systemic immunosuppression during chemotherapy, and COVID-19 infection will exacerbate their clinical situation further. Thus, before any patient is admitted for chemotherapy, COVID-19 testing should be confirmed negative. For glioma patients who are COVID-19 positive, chemotherapy should be postponed until they have complete recovery. It is also crucial to closely monitor patients' lymphocyte counts during chemotherapy. It is well known that in patients with human immunodeficiency virus infection (also an RNA virus as COVID-19), the CD4 count is significantly decreased at a median lymphocyte count level of 500 cells/μL. Thus, extra precaution should be taken for glioma patients with low CD4 count.
With regard to other treatments for glioma patients during the COVID-19 pandemic, one should balance the benefits of such treatment with the risk of possible COVID-19 infection. That means any treatment should be only initiated after confirmation of COVID-19 negative. For patients enrolled in clinical trials, treatment may be continued once they test negative for COVID-19.
What needs to be emphasized is that for any facility where asymptomatic patients are managed under routine precautions, once a patient is confirmed to be COVID-19 positive, the affected area must be isolated for disinfection. In addition, all persons who have close contact with the affected individual must be isolated for 14 days under close observation.
As I mentioned earlier, the COVID-19 pandemic has affected our medical resource supply chains. Consequently, when treating patients with gliomas, we must also take into consideration resource shortages, including medical equipment and medications. Due to travel restrictions and the need for physical distancing to reduce infection transmission, more and more medical centers are now switching to virtual multidisciplinary rounds and consultations. Similarly, many patients are now unable to travel for consultations and treatment. However, they, too, should be encouraged to take advantage of virtual healthcare options using platforms such as WeChat.
Our patients with glioma may become infected with COVID-19. We as healthcare professionals will work tirelessly through these trying times to ensure their safety, and we will be at their side to provide the best possible treatment and care. With the joint efforts from all over the world, this pandemic will surely end soon.
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