The coronavirus disease 2019 (COVID-19) pandemic had a profound and unprecedented impact on the diagnosis and management of patients worldwide. Healthcare systems were restructured to prioritize patients requiring intensive care, leading to significant delays in the management of other diseases, including cancer [1], [2], [3]. Cancer patients have been especially vulnerable, showing higher mortality rates when infected by COVID-19 [4]. To reduce their risk, many countries suspended cancer screening programs, and treatments such as surgery or radiotherapy were postponed, resulting in delayed diagnoses and care [4]. Studies have demonstrated that there is an association exists between shorter times to diagnosis and more favorable outcomes for symptomatic cancer, in terms of improved survival, quality of life, although these benefits ranged between cancers [5]. In the United Kingdom, delays due to the pandemic were expected to lead to an increase in avoidable cancer deaths [2], [6].

Newly diagnosed cancer patients are particularly susceptible to the negative impact of deferred diagnosis and treatment. Even modest delays in cancer surgeries significantly affect survival [7]. A meta-analysis revealed that a delay of just four weeks in cancer treatment increases mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers: bladder, breast, colon, rectum, lung, cervix, and head and neck [8]. In the United States, delays in treatment initiation for early-stage cancers—such as breast, lung, renal, and pancreatic—were linked to increased mortality [9].

Neuro-oncology has not been spared. The pandemic led to a reduction in patient referrals, fewer treatments, and delays in new diagnoses [10]. For neuro-oncology patients, whose disease can rapidly progress, these disruptions are particularly concerning. Studies have shown that delays in receiving treatment, such as radiotherapy, are critical predictors of overall survival for patients with high-grade gliomas [11]. The urgent need to address these delays calls for policy interventions to mitigate the pandemic's impact on neuro-oncology care. In France, the French National Cancer Institute (INCa) issued specific guidelines to ensure cancer treatment continuity during the pandemic [12]. Surgery is the main modality treatment for solid tumors and was prioritized to continue during COVID-19 outbreaks [3]. Centers developed priority systems for tumors that were not to be delayed. High-grade glioma (grades 3 and 4) surgery was still considered as urgent and continued without delay, while patients with low grade gliomas were managed under a ‘watch and wait’ strategy until resources became more available [10].

During the first wave of the pandemic starting in March 2020, France implemented two nationwide lockdowns – from March 17 to May 11, 2020, and from October 28 to December 15, 2020 –. Hospitals have made significant changes, restructuring their healthcare services, aiming to face the challenges posed by the pandemic. Delays in cancer care, particularly for newly diagnosed cases, were reported, affecting women more frequently and impacting breast, prostate, and non-metastatic cancers [1].

However, little is known about the specific impact of the COVID-19 pandemic on the care pathways of glioma patients. To our knowledge, no studies have yet investigated how the pandemic has affected treatment timelines for this population. Identifying these data is crucial for improving cancer care systems and better preparing for future epidemics. In this study, we investigated the impact of the COVID-19 pandemic and national lockdowns in France on timelines of the care of glioma patients.