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

Abstract BACKGROUND The COVID-19 pandemic and subsequent shutdowns led to significant disruptions in medical care and access to treatment for all medical conditions in the US in 2020. Institutional cohorts and survey-based studies have shown that there was significant care disruption for individuals diagnosed with primary brain tumors. In this analysis, we utilized a database containing ~80% of brain tumor diagnoses to assess the national impact of the pandemic on treatment patterns for glioblastoma. METHODS Data on newly diagnosed glioblastoma were obtained from the National Cancer Database, which includes hospital registry data from Commission on Cancer accredited facilities, for diagnosis years 2018-2020. Logistic regression was used to generate odds ratios (OR) of receiving resection, chemotherapy, or radiation after diagnosis in 2020 as compared to 2018-2019, after adjustment for potential confounders, including age at diagnosis, sex, race and ethnicity, insurance status, income, patient distance from diagnosing facility, Charlson comorbidity score, facility type and location, and MGMT methylation. RESULTS There were 7,184 glioblastoma, of which 5,873 were IDH-wt, diagnosed in 2020, a 3% decrease from the 2018-2019 average. For individuals with any newly diagnosed glioblastoma, there was a decrease in odds of resection (OR=0.91, p=0.047). Among those with any glioblastoma and a subset with IDH-wt glioblastoma there was a reduction in odds of radiation (OR=0.87, p=0.004 and 0.85, p< 0.001, respectively) and chemotherapy (OR=0.87, p=0.002 and 0.89, p=0.026, respectively). No decrease in odds of treatment was associated with a prior positive SARS-CoV-2 PCR test. CONCLUSIONS The COVID-19 pandemic caused significant disruption to health care for cancer patients in the US in 2020. For individuals with glioblastoma, in-person treatments decreased in frequency for individuals diagnosed in 2020 as compared to prior years. Further research is required to determine the impact this treatment disruption had on outcomes.