Impact of the COVID-19 pandemic on primary brain tumor incidence and management: Decisions that went right.

Background: The COVID-19 pandemic drastically altered cancer care. Prior reports demonstrated reduced screenings, diagnoses, and disrupted treatment regimens due to multifactorial reasons. We aim to analyze whether the same effects occurred within neuro-oncology.

Methods: This analysis included 70 131 patients with primary brain tumors from the SEER database from 2016 to 2021 identified via ICD10 code. The pre-COVID era was 2016-2019, peak-COVID was 2020, and post-COVID was 2021. Multivariate analysis was performed using logistic regression for binary variables and linear regression for continuous. Covariates controlled for were age at diagnosis, sex, and race. NCI SEER*Stat version 8.4.0 was used to calculate incidence rates age-adjusted to the 2000 US standard population and reported per 100 000 persons.

Results: Although there was a decrease in the age-adjusted incidence of primary brain tumors between 2016 and 2021, the number of malignant brain tumors remained stable, and this change was likely driven by a reduction in benign tumor incidence. Regarding treatment, in 2020 and 2021 all malignant brain tumors (2020 OR[95%CI]: 1.11[1.02-1.22], 2021: 1.10[1.01-1.020]) and glioblastoma patients (2020 OR[95%CI]: 1.12[1.01-1.26], 2021: 1.13[1.01-1.27]) underwent increased surgical resections, compared to pre-COVID years. Time from diagnosis to treatment decreased for glioblastoma patients in 2020, compared to pre-COVID (Estimate [95%CI]: -1.25 [-1.71 to -0.78]). No treatment changes were noted for benign brain tumors.

Conclusion: Malignant tumors, like glioblastoma, maintained a stable incidence due to their aggressive symptoms, though treatment patterns shifted. These findings reveal that the management of malignant brain tumors during the COVID-19 pandemic was effectively prioritized while maintaining quality of care.