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| LETTER TO THE EDITOR |
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| Year : 2021 | Volume
: 4
| Issue : 3 | Page : 62-63 |
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Need for specialized neuro-oncology units in low- and middle-income countries: Lessons learned from the COVID-19 pandemic
Jhoan Sebastián Robledo-Arias1, Veronica Arango-Machado2, Michael Gregorio Ortega-Sierra3, Ivan David Lozada-Martinez4
1 Department of Medicine, School of Medicine, Universidad del Quindio, Armenia, Colombia
2 Department of Medicine, School of Medicine, Universidad de Antioquia, Medellín, Colombia
3 Department of Medicine, School of Medicine, Corporación Universitaria Rafael Nuñez, Cartagena, Colombia
4 Medical and Surgical Research Center, Future Surgeons Chapter, Bogotá; Global Neurosurgery Committee, World Federation of Neurosurgical Societies, Cartagena, Colombia
| Date of Submission | 10-Aug-2021 |
| Date of Decision | 17-Oct-2021 |
| Date of Acceptance | 20-Oct-2021 |
| Date of Web Publication | 11-Nov-2021 |
Correspondence Address:
Dr. Ivan David Lozada-Martinez
Medical and Surgical Research Center, Future Surgeons Chapter, Bogotá
Colombia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/glioma.glioma_11_21
How to cite this article:
Robledo-Arias JS, Arango-Machado V, Ortega-Sierra MG, Lozada-Martinez ID. Need for specialized neuro-oncology units in low- and middle-income countries: Lessons learned from the COVID-19 pandemic. Glioma 2021;4:62-3 |
How to cite this URL:
Robledo-Arias JS, Arango-Machado V, Ortega-Sierra MG, Lozada-Martinez ID. Need for specialized neuro-oncology units in low- and middle-income countries: Lessons learned from the COVID-19 pandemic. Glioma [serial online] 2021 [cited 2023 Oct 1];4:62-3. Available from: http://www.jglioma.com/text.asp?2021/4/3/62/330193 |
Dear Editor,
We read with great interest the article published by Weller et al.[1] entitled "Neuro-oncology during the coronavirus disease 2019 (COVID-19) pandemic," wherein the authors commented on the impact of the COVID-19 pandemic on neuro-oncology practice in Europe and discussed challenges encountered and findings learned during this pandemic. We thank the authors for their insightful comments. However, the tools and strategies found in high-income countries may bias the true global impact of the delayed approach to the neuro-oncology patient, whether due to cancellation of elective surgery, delays in early diagnosis, and timely treatment. We would like to discuss the issue regarding neuro-oncology patients' access to health services during the COVID-19 pandemic in low- and middle-income countries, where many difficulties with respect to adequate care and follow-up existed even before the pandemic, which severely intensified during this time, and also the need to design specialized neuro-oncology units.
The development of neurosurgery and its branches in low- and middle-income countries is one of the main objectives of global neurosurgery.[2],[3] It is a mandatory requirement because of the disease burden caused by cerebrovascular diseases and tumors in these countries.[2],[3] During the COVID-19 pandemic, many of the objectives were delayed, and new goals were set with modifications needed to control the approaching disease burden owing to confinement and other public health security measures. However, this became a double-edged sword because even if the risk of severe acute respiratory syndrome coronavirus 2 infection was controlled, the development or progression of neurosurgical diseases for example could not be stopped, with evidence soon showing this to be true.[4],[5],[6] In the case of neuro-oncology patients, both the patients themselves and their caregivers were affected. Binswanger et al.[4] conducted a prospective study to evaluate the psychological burden of caregivers and neuro-oncology patients and observed that caregivers developed a median distress score of 8 (on a scale of 0–10) owing to tumor pathology compared with a score of 3 for COVID-19; furthermore, patients had a median score of 7 compared with a score of 5 for COVID-19.[4] Qualitatively, both groups mentioned that private and public restrictions and limited interaction with contacts were aspects of greatest concern.[4]
Mrugala et al.[5] conducted a global survey regarding the impact of COVID-19 on neuro-oncology and found that approximately 70% of specialists discontinued enrollment and participation in clinical trials, 69% of trainees developed distress, and approximately 50% did not receive professional support from their institutions. More than 30% of these professionals had their salaries reduced and 63% suspended their work.[5] All of these occurred because of organizational modifications in general hospitals and redistribution of resources among front-line departments, mainly owing to limitations in the development of high-quality research studies. Similarly, the CovidNeuroOnc study,[6] one of the most important studies of neuro-oncology in the world during the pandemic, found changes in the management of patients who were previously classified as suitable for surgery (16%) and chemotherapy (28%); this occurred because of institutional modifications and redistribution of resources, thus allowing the authors to conclude that the disruption in neuro-oncology practice delayed diagnosis and treatment, thereby compromising survival rates and functional outcomes of these patients.[6] However, these and the vast majority of similar data are obtained from high-income countries, and the real impact on third-world countries is unknown.
Based on the above findings, we propose the need to develop specialized neuro-oncology units with solid resources directed exclusively to this patient group to avoid the redistribution of resources and medical spaces, which compromises the normal practice of neuro-oncology. In addition, having specialized units will allow adaptation to social and public modifications in times of crisis in a more agile manner and maintain the recruitment and development of clinical trials and other research types.[7] In addition, having permanent teams of trained professionals dedicated to a specific discipline facilitates follow-up, data processing, and appointment and intervention scheduling to ensure that neuro-oncology patients have access to quality specialized services promptly, increase the probability of medium-term survival, decrease the risk of complications, and improve education and support for both patients and their caregivers.[8] There is much work to be performed currently in neuro-oncology, and the pandemic demonstrated that more funding and administrative and organizational research in neuro-oncology are needed. These specialized units could be an innovative option for improving health care processes, especially in times of crisis.
| References | |  |
| 1. | Weller M, Rhun EL, Roth P, Preusser M. Neuro-oncology during the COVID-19 pandemic. Glioma 2021;4:1.  [Full text] |
| 2. | Lozada-Martínez I, Maiguel-Lapeira J, Torres-Llinás D, Moscote-Salazar L, Rahman MM, Pacheco-Hernández A. Letter: Need and impact of the development of robotic neurosurgery in Latin America. Neurosurgery 2021;88:E580-1. |
| 3. | Ortega-Sierra MG, Durán-Daza RM, Carrera-Patiño SA, Rojas-Nuñez AX, Charry-Caicedo JI, Lozada-Martínez ID. Neuroeducation and neurorehabilitation in the neurosurgical patient: Programs to be developed in Latin America and the Caribbean. J Neurosurg Sci 2021. doi: 10.23736/S0390-5616.21.05439-4. |
| 4. | Binswanger J, Kohl C, Behling F, Noell S, Hirsch S, Hickmann AK, et al. Neuro-oncological patients' and caregivers' psychosocial burden during the COVID-19 pandemic-A prospective study with qualitative content analysis. Psychooncology 2021;30:1502-13. |
| 5. | Mrugala MM, Ostrom QT, Pressley SM, Taylor JW, Thomas AA, Wefel JS, et al. The state of neuro-oncology during the COVID-19 pandemic: A worldwide assessment. Neurooncol Adv 2021;3:vdab035. |
| 6. | Fountain DM, Piper RJ, Poon MTC, Solomou G, Brennan PM, Chowdhury YA, et al. CovidNeuroOnc: A UK multicenter, prospective cohort study of the impact of the COVID-19 pandemic on the neuro-oncology service. Neurooncol Adv 2021;3:vdab014. |
| 7. | Silva-Rued ML, Ramírez-Romero A, Guerra-Maestre LR, Forero-Hollmann ÁM, Lozada-Martínez ID. The need to develop specialized surgical centers: The evidence that surgical diseases cannot wait. Int J Surg 2021;92:106036. |
| 8. | Gardner MM, Aslanzadeh FJ, Zarrella GV, Braun SE, Loughan AR, Parsons MW. Cancer, cognition, and COVID: Delivering direct-to-home teleneuropsychology services to neuro-oncology patients. Neurooncol Pract 2021;8:485-96. |
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