Dear friends, dear colleagues

A few weeks ago, we announced that we were continuing to work on EANO 2020, hoping that by September 2020 the circumstances would allow this major European neuro-oncological event to happen. However, it is clear that even now when restrictions are gradually lifted many uncertainties about the COVID infection rate will remain over the entire summer period. Unpredictable travel limitations, unclear national policies on mass gatherings, and the chance of yet another surge in COVID infections make a productive and successful face-to-face EANO 2020 in early September unlikely. Therefore, we have taken the difficult decision to postpone the EANO 2020 Meeting in Glasgow to another year.

We have decided to develop a series of webinars instead, called eEANO, through which we will bring neuro-oncological updates to the EANO membership. These will start on September 10-13, the original dates of EANO 2020. We will continue eEANO as a series of webinars afterwards, which will be CME credited, for members only. We intend to provide both educational content and the latest scientific developments on clinical trials and laboratorial research as a continuing programme. Topics will be developed in collaboration with the membership. More information will be provided once we have finalized the details. The next planned EANO Meeting should take place in 2021. We will keep you posted on that situation and very much hope to welcome you to a ‘face-to-face’ conference next year.

I am very sorry not to see you in person in Glasgow this summer; not meeting colleagues is yet another loss that many of us deplore. I also apologize for not informing you earlier, but as you can imagine it has been complicated to reach a good solution with regard to the practical issues. Lastly, I want to recognize the many people who have worked hard to prepare the 2020 meeting, in particular our local chair Anthony Chalmers.  EANO is scheduled to come to Glasgow in 2024!

On behalf of the EANO board,
Martin van den Bent
EANO President

Dear fellow members of the EANO, dear colleagues, dear friends

Our societies are being shocked by a wave of the SARS COVID-19 infection, resulting in large numbers of patients being severely infected, requiring hospital and ICU admission in a sizeable proportion of affected individuals. The end of this wave of infections is not in sight, fundamentally affecting our societies, disrupting our health care systems. That disruption is not limited to the demands this wave of SARS patients requests from our health care system, but also the care of other patients with other diseases: they need to be cared for as well. That care needs to be as good as possible, according to the existing guidelines and treatment standards, but also in consideration of health care limitations that may occur and of new safety issues the wave of COVID-19 infections brings to other patients and their caregivers. For us, as neuro-oncologists, apart from all our other concerns, brain tumor patients are our concern and it is our responsibility to take care of them to the best of our abilities.

The data on the impact the COVID-19 infection on cancer patients are still very limited. Current data on risks come in particular from China, where the pandemic started, and epidemiological data have been collected. A first report on few cancer patients suggests that patients with cancer but also cancer survivors have a higher risk of severe COVID-19 events (1). Because of the limited numbers of cancer patients, the conclusions of that study are questioned. Still, the observations led the authors to a number of possible considerations, including postponing adjuvant chemotherapy or elective surgery for stable cancer in endemic areas, stronger personal protection provisions for patients with cancer or cancer survivors, and more intensive surveillance or treatment should be considered when patients with cancer are infected with SARS-CoV-2, especially in older patients or those with other comorbidities.

Data on brain tumor patients are not available yet, it will take time for those data to emerge. Many of our patients are above 60 years of age, receive or have received chemotherapy and do travel to hospitals – especially in endemic area’s another risk factor. General guidelines for this situation cannot be given, as the situation differs from one region to another, even within countries. Also, while postponing treatments may be wise for certain patients, it may be hazardous in other patients in whom treatment cannot be postponed without jeopardizing outcome. This requires us to take decisions on a patient-by-patient and an institution-by-institution basis, based on tumor risk assessment and the situation at your institution and region. Of course, all such considerations have to be discussed with patients and caregivers; and should not be driven by fear alone but on a careful weighing of all information – in particular also on long term benefit of treatment.

A few recommendations and considerations that come to mind:
• Recommend high levels of carefulness to our patients (hygiene, social distance)
• Develop teleconsultation for patients, lab tests at outside hospital facilities if face to face contact can be safely avoided
• Consider stretching control MRI appointments in asymptomatic, long-term survivors of less malignant brain tumors, e.g., meningiomas, schwannomas.
• Consider hypofractionated radiotherapy schedules limiting the number of visits to the hospital for patients’ tumors in which this is likely to be feasible without affecting outcome
• Consider to postpone treatment if this is considered safe and feasible, e.g. probable or proven WHO grade II IDH mutant glioma
• Reconsider the risk benefit ratio of chemotherapy, e.g. in MGMT promoter unmethylated glioblastoma, notably in the elderly
• Be more strict in who you operate, postpone is safely possible, avoid if clinical benefit is less likely or marginal

It is important to realize we do not know when the situation will become more normal again. That requires us not to interrupt ongoing treatments without solid reasons. Nor should we interrupt follow-up of patients; if we do, we will be facing a bow wave of care later on. Regular care should go on as long this is safely possible. Lastly, our patients face emotional distress and anxiety – they know they are more vulnerable. This may require further support. I wish you all strength and please, take care!

On behalf of the EANO board,
Martin van den Bent
EANO President
REFERENCES: 1. Liang W, Guan W, Chen R, et al.: Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21:335-337, 2020 DOI: 10.1016/S1470-2045(20)30096-6

Dear fellow members of the EANO, dear colleagues, dear friends

Our world is in disarray. With daily increasing numbers of people affected by and dying from COVID-19 our health care systems are under an intense pressure, and anxiety rules. The measures take to control this pandemic are rigorous, painful but necessary, and we all hope they will help us to manage this global crisis. Days like these also help us to remind us what really matters in life. Many of us will have had the experience of loved ones and colleagues falling ill to this virus. Certainties of our now global community have disappeared overnight.

In these days, it is important to continue to give the right care and attention to our brain cancer patients, as even without a virus, these patients and their families face similar existential threats and they depend on us. The virus has not made our task easier, perhaps even more important. With all measures taken, within a few weeks our way of living has completely changed, and it is unclear when things will begin to turn to normal again. This affects our daily routine, our family lives, but also our professional lives.

I am writing you also because of the upcoming EANO 2020 Meeting to be held September 10 - 13 in Glasgow, Scotland. This is more than five months from now, but we cannot forecast what the world will look like at that time. At present, we want to continue to plan for the meeting and postpone any decision on the continuation of the meeting until the end of May. So please, do submit your abstracts, and should for the EANO annual meeting the worst come to the worst, all registration fees will be refunded. In the event a face to face meeting is considered not feasible, we are planning for an ‘eEANO’ for EANO members, to at least update you of the many recent important developments within our field.

For now, I wish you and your families, friends and colleagues strength and luck, and remember, we are in this together: together we will overcome this crisis.

On behalf of the EANO board and EANO offices,
Martin van den Bent
EANO President