June 8 is marked as the Brain Tumor Day. This initiative was initially taken by German Brain Tumor Association and is adopted worldwide to raise awareness and educate people about brain tumors.
Recently the world has been rattled by the ongoing Coronavirus infection (COVID19) and as the entire heath care facilities and focus has shifted to fight the highly contagious virus infection, brain tumor patients are finding it difficult to understand and respond to this situation adequately, resulting in undue stress and anxiety.
There are many myths and misconception among the general population related to the coronavirus and how it can affect persons following the brain tumor diagnosis and treatment.
I would like to take this opportunity to discuss some of the basic facts related to brain tumor management during Covid 19 pandemic.
In general, individuals with chronic conditions and/or compromised immune systems are likely at higher risk for contracting the virus as well as experiencing a more severe illness after infection.
Many brain tumor patients, especially malignant brain tumor patients, are considered high-risk, as chemotherapy, steroids and radiation therapy can compromise a patient’s immune system, making them more susceptible to COVID-19 as well as the severity of infection.
Hospital Visits and Consultation
Many hospitals have started online consultation for patient in these difficult times. Ask your doctor if a scheduled visit/consultation can be conducted by phone, tele/video conference, or other effective methods.
Before the online consultation one should be ready with clinical summaries and current medication charts lab data in hand for easy reference.
If the hospital visits are unavoidable, please be aware that as hospitals must protect their patient populations and staff, you may see many restrictions at your treating hospital that include reduced entry points into the hospital, a screening of visitors for COVID-19 etc.
It’s always better to visit the website of your treating hospital or call your treatment team ahead of your next appointment to prepare yourself for any changes that await you upon arrival to avoid unnecessary delay in getting scheduled consultation.
If you need blood drawn for your regular routine lab tests you better get it done at your home if possible, to prevent unnecessary waiting at the hospital.
It is a common practice to scan patients with brain tumor in regular intervals even after years of stable disease and in such condition delaying scan at the peak of pandemic may be possible.
Discuss about this possibility with your treating doctor.
Who Can Postpone Treatment for Brain Tumor?
Traditionally brain tumors are not staged like other cancers. Brain tumors are broadly classified either as benign or malignant and malignant tumors are again sub divided as per their pathological grades into high or low grade.
In general, any tumor, which is immediately life threatening or can cause rapid neurological deterioration or aggressive in behavior (like a glioblastoma) should be treated immediately with surgery, radiation, chemotherapy, or different combinations of these as per indication.
On the other hand, in slow growing tumors like meningiomas and schwannomas, surgery can be delayed to some extent.
However, every patient is different from the other in terms of their tumor and it’s behaviour and necessary treatment required for each.
So, patients should discuss their condition with an experienced doctor in this field and only he/she can decide on the appropriate treatment on a case-to-case basis.
Please remember that COVID19 has not changed management protocol of brain tumors yet. However, it may be justified to discuss with your doctor about alternatives treatment modalities which are available like radiosurgery or temporary methods to tide over the present situation like shunting so that definite treatment can be undertaken later.
Bottom line on this matter is decision making is a highly complex and technical process and to suggest an idealistic and holistic approach in this crucial time should be the job of your doctor.
Can Radiotherapy be Delayed?
The management principle of radiotherapy to treat brain tumors will remain the same.
It is important to remember that radiation has a time effect and the benefit of radiation after surgery is best when given within that specified period mostly within 4-6 weeks after surgery.
In very selective instances, when the risk of tumor recurrence or progression is negligible over the period of expected delay like, low-grade gliomas, craniopharyngiomas, meningiomas, patient can wait.
Please discuss with your surgeon or radiation oncologist about potential risk-benefits of that approach.
If treatment has already been initiated, it is important to complete radiation within stipulated time to get the maximum benefit of radiation.
Can Chemotherapy be Delayed:
Treatments such as chemotherapy can weaken your immune system and may increase your risk of any infection, including COVID-19.
However, at this point time, there is no evidence to support to delay or withhold a scheduled chemotherapy or immunotherapy in patients with cancer. Withholding critical anti-cancer or immunosuppressive therapy is not currently recommended.
During chemotherapy, there will be times in your treatment cycle when you are at increased risk of infection and one should take extra precaution shield oneself from contracting infection during this critical period.
What will happen if I contract COVID-19 infection while on treatment?
Please inform the healthcare workers about your medical condition and inform your treating doctors. They might suggest some modification in your medications or admission to a health care facility depending on your general condition.
Don’t stop any medicines on your own especially anti-seizure medicines as fever can trigger seizures. Don’t worry unnecessarily as there is a very high chance that the whole episode will pass by uneventfully.
What about vaccine if I’m getting treatment?
You can still receive the vaccination if you are getting treatment for your brain tumor.
Public health experts and cancer specialists have agreed that people living with cancer should receive the vaccine. Your immune system needs to be working at some level to respond to the vaccine, it is possible that it may be slightly less effective for people having chemotherapy or other adjuvant cancer treatments.
But it is still expected that the vaccine will give some useful protection against the virus and it’s advisable that you take it at the earliest possible opportunity.
If your cancer treatment is affecting your immune system, your healthcare team will advise you on the best time to get your COVID-19 vaccine.
(Dr Sajesh K. Menon is a professor and Head of Neurosurgery in Amrita Hospitals.)