The Covid-19 pandemic has globally affected pediatric cancer care.
A cross-sectional study, from Dylan Graetz, MD, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, and colleagues, involving pediatricians from institutions across the world, showed that the Covid-19 pandemic has substantially disrupted pediatric cancer diagnosis and management, particularly in low- and middle-income countries. Their study was published in The Lancet Child & Adolescent Health.
It is well known that patients with comorbidities are at risk for worse outcomes if infected with Covid-19, and initial fears were that pediatric oncology patients would suffer severe disease. And, while the mortality associated with infection among this population (approximately 4%) is higher than in the general pediatric population, the rate is well below that of the adult cancer population.
However, Graetz and colleagues pointed out that Covid-19 poses other threats to children with cancer. “Pediatric oncology care is reliant on prompt evaluation and diagnosis, referral to tertiary centers, multidisciplinary subspecialized teams, timely and coordinated multimodal therapy, and access to supportive care, all of which have been affected by this pandemic,” they explained.
The objective of this study, then, was to evaluate the effect of Covid-19 globally on pediatric cancer services.
The study included a cross-sectional survey of 60 items designed to assess institution characteristics, the number of patients diagnosed with Covid-19, disruptions to cancer care, adaptations to care, and resources available for care. This survey was distributed worldwide to pediatric oncology providers through the St. Jude Global Alliance and International Society for Pediatric Oncology listserves and regional networks from June 22 through Aug. 21, 2020.
Responses from 311 health care providers from 213 institutions in 79 countries were included for analysis.
Among the study’s findings:
- Fifteen (7%) of the institutions reported they had, at one point, completely closed their pediatric hematology-oncology services for a median of 10 days, and ranging from 1 to 75 days.
- Five of 213 centers were no longer evaluating new cases of suspected cancer, while 43% (90 of 208) of the remaining centers described a decrease in newly diagnosed pediatric cancer cases.
- About one-third (34%) of centers reported increased treatment abandonment.
Other ways in which cancer care was disrupted included reductions in surgical care, shortages of blood products, modifications to chemotherapy, and interruptions in radiotherapy regimens.
For example, among the 121 institutions that reported changes in chemotherapy management, 69% reported a decrease in dose intensity, 49% reported a modification from intravenous to oral formulations, and 21% reported a complete discontinuation of chemotherapy for patients — and, of the the 155 institutions providing radiotherapy before the pandemic, 10% reported completely discontinuing radiotherapy, while 20% reported they were only administering urgent radiotherapy.
The decrease in newly diagnosed pediatric cancer cases during the pandemic reported by some centers did not vary between high-income and low- and middle-income countries. However, reports of the unavailability of chemotherapy agents, treatment abandonment, and interruptions in radiotherapy were more frequent in low- and middle-income countries.
Pediatric cancer care institutions were hit hard financially, as well. Half reported a decrease in available resources during the pandemic, while about two out of every three reported a decrease in financial support from public and governmental institutions.
Pediatric care centers also experienced staffing shortages, mainly due to Covid-19 infection among staff (60%) and quarantine due to exposure (74%). About 8% reported the death due to Covid-19 of at least one staff member who cared for children with cancer.
In a commentary accompanying the study, Soad Fuentes-Alabi, MD, MPH, from the National Children’s Hospital Benjamin Bloom, San Salvador, noted that low- and middle-income countries, such as those in Latin America, have responded to the pandemic by implementing new policies and distributing resources.
For example, Fuentes-Alabi pointed out that in El Salvador the national pediatric cancer program team encouraged the use of telemedicine to optimize care through video calls. In addition, pediatric oncology units implemented physical distancing measures, reorganized staff into 12-hour shifts per group, and had non-essential personnel do telework to reduce exposure.
Graetz and colleagues noted that in their study 69% of institutions reported instituting new or adapted checklists for patient and staff safety, 63% reported implementing new processes for communication with patients and families, while 56% added new guidance on essential services. Most (80%) also reported placing increased emphasis on infection prevention and control in their hospitals.
“Our findings emphasize the need for continued global prioritization of pediatric cancer care and equitable distribution of global resources to support treatment continuity during the Covid-19 pandemic and future public health emergencies,” Graetz and his colleagues concluded.
- The Covid-19 pandemic has substantially disrupted pediatric cancer diagnosis and management, particularly in low- and middle-income countries.
- Institutions reported shortages of blood products, interruptions in radiotherapy regimens and the necessity of modifying chemotherapy during the pandemic
Michael Bassett, Contributing Writer, BreakingMED™
None of the authors quoted in this article disclosed any relevant relationships.
Cat ID: 190
Topic ID: 79,190,730,933,118,935,190,926,138,151,928,925,934
