Cancer Research, Statistics, and Treatment

: 2020  |  Volume : 3  |  Issue : 2  |  Page : 342--343

Authors' reply to Shetty et al.

Rakesh Jalali1, Jayant S Goda2, Vijay Patil3,  
1 Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
2 Department of Radiation Oncology, Neuro Oncology DMG, Tata Memorial Centre, Parel; Homi Bhaba National Institute, Mumbai, Maharashtra, India
3 Homi Bhaba National Institute; Department of Medical Oncology, Neuro Oncology DMG, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India

Correspondence Address:
Rakesh Jalali
Apollo Proton Centre, 100 Feet Road, Taramani, Chennai - 600 041, Tamil Nadu

How to cite this article:
Jalali R, Goda JS, Patil V. Authors' reply to Shetty et al. Cancer Res Stat Treat 2020;3:342-343

How to cite this URL:
Jalali R, Goda JS, Patil V. Authors' reply to Shetty et al. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 28 ];3:342-343
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Full Text

We thank Shetty et al.[1] for their insightful and encouraging reply to our initial review on modifying the neuro-oncology treatment protocols, during the early phase of the ongoing coronavirus disease-2019 (COVID-19) pandemic.[2] Shetty et al. in their letter further highlighted neurosurgery and neurosurgical oncology care amid these testing times. We endorse the authors' views about difficulty in the decision-making process for neurosurgical procedures, which, to say the very least, is inherently complex, that has been augmented by the current situation making it even more challenging in clinical practice. We reiterate, what we stated in our published report, that risk stratification and scaling down of non-essential neurosurgical patients should be considered on a case-to-case basis, not only to minimize the patients' hospital stay but also to minimize the exposure of the health care staff.[2],[3] We are grateful to Shetty et al. for sharing the experience from their center and elucidating policies for patient screening, COVID-19 testing, and taking appropriate steps to ensure the safety of patients and medical personnel in the operation rooms, intensive care units (ICUs), and other hospital areas. Moreover, they rightly highlighted the challenges of administering optimal emergency neurosurgical care in patients who require it and the attendant risk of infection due to the possible prolonged ICU stay. The decision to operate on patients requiring an emergency intervention must be based on the hospital policies and the preparedness of the staff to handle such a situation while considering both, an increased risk of infection for the healthcare workers and the potential clinical gains in terms of the improved neurological status for the patient. This has also been corroborated in a recent report by Gupta et al., who have suggested a pragmatic decision-making tree to prioritize patients as acute, subacute, and chronic cases, which may be applied to surgically triage patients with brain tumors.[4] Each patient should be screened and approved by the individual hospital/center's guidelines and the infection committees' recommendations, taking into consideration the risks versus benefit for that case.[5] We had previously emphasized and completely agree with Shetty et al. that the guidelines should be pragmatic and the suggested treatment policies, whether surgical, adjuvant, or ancillary, be adapted to each center's need, the type of patients, and the preparedness of the center and its workforce.

The COVID-19 pandemic has undoubtedly posed great challenges, for both neuro-oncologists and neurosurgeons worldwide. The situation is no different in India, considering the changing landscape of the infection and its associated morbidity and mortality. It is in the interest of the neurosurgeons and neuro-oncologists that flexible and pragmatic decisions be taken when treating patients with brain tumors during these testing times, so as to achieve the right balance between improving the outcomes of these patients and protecting our healthcare system. It is also expected that the guidelines may change rapidly as the situation evolves and depending upon the national and institutional policies; we should therefore be open to embrace them.

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Conflicts of interest

There are no conflicts of interest.


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