Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer.
Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints.
Background
EORTC study 22033-26033 showed no difference in progression-free survival between high-risk low-grade glioma receiving either radiotherapy (RT) or Temozolomide (TMZ) chemotherapy alone as primary treatment. Considering the potential long-term deleterious impact of radiotherapy on memory functioning, this study aims to determine whether TMZ is associated with less impaired memory functioning.
Methods
Using the Visual Verbal Learning Test (VVLT), memory functioning was evaluated at baseline and subsequently every 6 months. Minimal compliance for statistical analyses was set at 60%. Conventional indices of memory performance (VVLT Immediate Recall, Total Recall, Learning Capacity, and Delayed Recall) were used as outcome measures. Using a mixed linear model memory functioning was compared between treatment arms and over time.
Results
Neuropsychological assessment was performed in 98 patients ( 53 RT, 46 TMZ). At 12 months compliance had dropped to 66%, restricting analyses to baseline, 6 months, and 12 months. At baseline, patients in either treatment arm did not differ in memory functioning, gender, age, or educational level. Over time, patients in both arms showed improvement in Immediate Recall (p = 0.017) and total number of words recalled (Total Recall; p < 0.001, albeit with delayed improvement in radiotherapy patients (group by time; p = 0.011). Memory functioning was not associated with radiotherapy gross, clinical, or planned target volumes.
Conclusion
In patients with high-risk low-grade glioma there is no indication that in the first year after treatment radiotherapy has a deleterious effect on memory function when compared to TMZ chemotherapy.
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