COVID-19 and the delivery of neuro-oncology services: The South Tees Brain and CNS tumour Multidisciplinary team (MDT) experience

Introduction: It is widely reported that the COVID-19 pandemic has significantly disrupted the delivery of health care, importantly the provision of cancer services. We have assessed the impact on our unit. Method: A retrospective audit of adult patients referred to the South Tees Brain and CNS Tumour MDT with suspected diagnosis of malignant glioma between 01/04/20-31/03/21 (COVID-19 period) and compare with pre-COVID cohorts from 01/01/18-31/12/19 and 01/01/13-31/12/14. Results: 64 referrals were received in the COVID-19 period compared to average of 75 per year in 2018/2019 and 83 per year in 2013/2014. Online MDTs were introduced. The mean interval from referral to MDT decision was 5.4 days during the COVID-19 period (not statistically different to pre-pandemic values). Telephone clinics were introduced which comprised 39.5% of pre-operative neurosurgery clinics. All surgical pre-assessments were changed to hybrid of telephone consultation with shortened face to face meeting for examination and routine blood tests. Day of surgery admission increased significantly to 42.1% in the COVID-19 period compared to 25.8% 2018/19 and 9.4% in 2013/14. Average length of stay was significantly reduced to 4.7 days compared to 7.9 days in 2018/19 and 9.5 days in 2013/14. There were no COVID related complications or increased re-admissions. Conclusions: The COVID-19 pandemic had a minimal effect on the number of referrals to our MDT. Modification of clinical and pre-operative assessment processes combined with streamlined surgical pathways ensured continued provision of timely care. The pathway changes implemented during COVID should be evaluated further and where relevant continued after the pandemic.