Impact of COVID-19 pandemic in hospitalizations due to brain tumors from the epicenter of Latin America

Portugal, I. B. M.; De Carvalho, L. E. W.; Schoueri, J. H.; Rezende, L. F. M.; Fonseca, F. L. A.; Ferrari, G.; De Abreu, L. C.; Adami, F.

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. In Brazil, the disease had its first case in the city of São Paulo, thus being the starting point and epicenter of this disease in Latin America. Neurological features are currently well recognized in COVID-19 indicating the neurotropic nature of the virus and include anosmia, myalgia, myositis, encephalitis, meningitis, cerebrovascular disease, Guillain-Barré syndrome, and postinfectious myelitis. CNS tumors though relatively rare (> 2% of all cancers) are a relevant source of cancer-related morbimortality worldwide. Although studies have reported higher COVID-19 severity in cancer patients, the consequences of the pandemic on health care for CNS tumors remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the hospital admissions (HA) due to CNS tumors in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to CNS tumors in the city of São Paulo comparing the outbreak period (January-June 2020) and a prepandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to CNS tumors was observed during the outbreak period (January-June 2020). Benign neoplasm of brain and other parts of CNS (-2, CI -2 to -1) and malignant neoplasm of brain (-5, CI -7 to -3) showed to be remarkably affected (see table). To our knowledge, this is the first scientific report of significant reduction of HAs due to CNS tumors during COVID-19 era. Conclusions: Our findings seem to be associated to delayed oncological diagnose and care to CNS tumor patients during the lockdown and health system collapse. A rebound helpseeking effect as well as more severe complications may present in the post- pandemic. Further studies are needed to evaluate the impact of the ongoing pandemic in CNS neoplasms in order to strategically corroborate public health actions for short- and long-term implications of COVID-19 pandemic.