Impact of COVID-19 on pediatric cancer care

Research has shown that coronavirus disease 2019 (COVID-19) has low mortality in children with cancer. However, the impact of the disease on how health care is provided has had an impact on the delivery of cancer care. A report in The Lancet Child & Adolescent Health looked at how COVID-19 impacted childhood cancer care across the world.¹

The investigators used a cross-sectional survey and sent it to domestic and international pediatric oncology providers from June 22, 2020, to Aug 21, 2020, using International Society for Paediatric Oncology listservs and regional networks as well as the St. Jude Global Alliance. The survey had 60 questions that covered the number of patients diagnosed with COVID-19, institution characteristics, disruptions to cancer care such as treatment abandonment, adaptions to care, and resources, including clinical staff availability and personal protective equipment stores. Surveys with less than two thirds of the questions answered were not included in the analysis.

A total of 311 health care professionals from 213 institutions in 79 countries were included in the analysis. One hundred eighty-seven institutions reported having the capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a median of 2 (range 0–350) SARS-CoV-2 infections per institution were recorded in children who had cancer. A complete closure of pediatric hematology-oncology services occurred in 15 institutions (median 10 days, range 1–75 days). Five institutions said they were not evaluating new cases of suspected cancers and 90 institutions noted a decrease in new pediatric cancer diagnoses. The decrease in new diagnosis didn’t vary based on country income status (p=0.14). Treatment abandonment increased in 73 institutions. A number of changes to cancer care included reduced surgical care (153 institutions), blood product shortages (127 institutions), chemotherapy modifications (121 institutions), and radiotherapy interruptions (43 of the 155 institutions that provided it before the pandemic). Low- and middle-income countries saw more frequent treatment abandonment, interruption in radiotherapy, and unavailability of chemotherapy agents than high-income countries. The pandemic led to new or adapted checklists (146 institutions), new processes for communication with patients and families (134 institutions), and new or adapted guidelines for essential services (119 institutions).

The investigators concluded that pediatric oncology services were seriously affected by the pandemic. They urged an equitable and robust global response to support such services for the rest of the pandemic, as well as in future public health crises.

Reference

1. Graetz D, Agulnik A, Ranadive R, et al. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Health. March 3, 2021. Epub ahead of print. doi:10.1016/s2352-4642(21)00031-6