Studies show that the COVID-19 pandemic has had a significant impact on childhood cancer treatment

The COVID-19 pandemic has had a significant impact on childhood cancer treatment worldwide, according to a survey of more than 300 clinicians from 200 hospitals worldwide. Lancet Child & Adolcent Health journal.

The first global assessment of the impact of COVID-19 on childhood cancer treatment revealed that more than three-quarters (78%) of the hospitals surveyed affected childhood cancer treatment. ..

Almost half (43%) reported fewer new cases than expected, and about one-third (34%) reported an increase in the number of patients who abandoned treatment.

The study also found that at some stage of the pandemic, 1 in 10 (7%) completely closed the childhood cancer unit. Of the 15 units closed, 13 (87%) were in LMIC, with an average closure time of 10 days.

COVID-19 puts a lot of pressure on hospitals and medical systems around the world. Previous studies have reported delays in the diagnosis and care of childhood cancer patients during a pandemic at the national or regional level. The survey released today adds the views of healthcare professionals around the world on the care that hospitals can provide.

Daniel Moreira, MD, MD, St. Jude Children’s Research Hospital, USA, said: Our results are relative to the various medical systems around the world, as LMIC hospitals have been tense before the pandemic, have scarce resources and access to care for children with cancer. It seems to reflect the strength. “

Widespread impacts have been identified worldwide, including reductions in available clinical staff, childhood cancer beds, and personal protective equipment (PPE). However, the results suggest that among the frequently reported problems, the effects of LMIC are more pronounced due to lack of treatment, discontinuation of treatment, and changes in chemotherapy due to discontinuation of radiation therapy. ..

The authors of the new study will impact COVID-19’s global impact on childhood cancer treatment by designing a cross-sectional study distributed to hundreds of healthcare professionals worldwide through international and regional networks. I evaluated it.

The study will cover the period June 22-August 21, 2020, and will vary in assessing hospital characteristics, the number of patients diagnosed with COVID-19, and the confusion and indications for cancer treatment. The question was included.

The survey was completed by 311 healthcare workers from 213 institutions in 79 countries. Countries were grouped as low-income, low-middle-income, high-middle-income, and high-income. Responses were analyzed at the institutional level.

Most hospitals (83%) are in LMIC and the majority (88%) were able to test for COVID-19. The authors found that the impact of pandemics on childhood cancer treatment was largely independent of the number of COVID-19 cases at the individual hospital or national level.

The findings suggest that childhood cancer treatments worldwide are affected by COVID-19, with more than three-quarters (78%) of hospitals having some impact on their ability to treat.

Significant confusion in cancer diagnosis was reported, with nearly half (43%) of hospitals diagnosing fewer new cases than expected. Impacts on the ability of hospitals to provide cancer treatment were also noted, with one in three (34%) reporting an increase in the number of patients who were not started or were delayed for more than four weeks. -Known as abandonment of treatment.

Several effects on the management of childhood cancer have been reported, including a reduction in surgery in most hospitals (79%). More than half pointed to a lack of blood products, but a similar percentage changed chemotherapy due to a lack of treatment (60% and 57%, respectively). Radiation discontinuation was also significant, with nearly one-third (28%) reporting discontinuation of treatment.

Hospital resources were significantly impacted, with one-third (32%) pointing to a decrease in financial support and two-thirds (66%) reporting a decrease in available clinical staff. Approximately one (19%) of the five hospitals noted reduced availability of beds for childhood cancer.

Almost one (7%) of the 10 hospitals required complete closure of the childhood cancer unit at some point, with an average closure period of 10 days. Most of these (87%) were in LMICs, and while some of their impact on childhood cancer treatment did not change with national income levels, LMICs were disproportionately affected in many areas. I did.

This includes changes in chemotherapy due to lack of treatment (40%, 45%, 40% in low-income, low- and middle-income countries, and 11% in high-income countries, respectively) and higher rates. It will be. Percentage of treatment abandonment (compared to 38%, 52%, 33% of low-income, low-middle-income, and high-middle-income, respectively, 8% of high-income), and more frequent interruptions in radiation therapy (78%, low-income) , Low-middle income and high-middle income are 68% and 46%, respectively, while high income is 10%.

LMIC hospitals also reported more frequently reduced access to life-saving interventions (8%, 33%, and 16% for low-income, low-middle-income, and high-middle-income, respectively, compared to 3% for high-income. ), And unexpected deaths (31%, 36%, and 13% of low-income, low-middle-income, and high-middle-income, respectively, compared to 8% of high-income).

LMIC hospitals were also likely to report a reduction in regular government funding for cancer treatment (high income, compared to 15%, 52%, and 31% of low, low, and high middle income, respectively. ).

Dylan Graetz, MD of St. Jude Children’s Research Hospital, USA, said: “The long-term impact on childhood cancer outcomes is not yet clear. A successful strategy to address the adverse effects on childhood cancer treatment.”

Most hospitals have introduced new policies and guidelines to support childhood cancer treatment during pandemics, with more than two-thirds (69%) using new or adapted patient and staff safety checklists. New processes for patient-family communication (63%) New guidance on essential services (56%) was also common. The authors found that many of these were well received by hospital staff and could be beneficial beyond the pandemic.

The COVID-19 pandemic has created additional barriers to childhood cancer treatment, but we are a resilient community that can transform some of the indications enforced by the pandemic into the future of cancer treatment. Proved. “

Laila Hesssen, Professor at Mohammed V University

The author is aware of some restrictions. The survey results only reflect the knowledge and opinions of the respondents at some stage of the rapidly changing pandemic.

The study was conducted in English and distributed within two pediatric oncology networks, so the results are if staff do not speak English and cannot be generalized to a small, resource-poor configuration that is not part of these networks. there is.

The survey covered a variety of topics and took about 60 minutes to complete. This could have exhausted the survey and resulted in a relatively large number of incomplete answers. Nonetheless, the authors believe that the study captured a comprehensive account of the global impact of this pandemic on pediatric tumor treatment.

This report is part of a COVIMPACT study aimed at understanding the impact of the COVID-19 pandemic on childhood cancer treatment. In addition, this work is linked to the Global COVID-19 Observatory and Resource Center for Childhood Cancer (covid19childhoodcancer.org), a collaboration between St. Jude Children’s Research Hospital and the International Society for Pediatric Oncology (SIOP).

In a linked comment, Dr. Soad Fuentes-Alabi of the Ayuda Mobivil Foundation Medical Center and Benjamin Bloom, National Children’s Hospital in El Salvador, said such a study would challenge providing pediatric cancer treatment at LMIC in a public health emergency. It states that it emphasizes. “In low- and middle-income countries, including Latin America, the common problems of delayed diagnosis and discontinuation or discontinuation of treatment are exacerbated during a pandemic.”