Study Calls for Reassessment of Childhood Cancer Care Delivery In Light of COVID-19 Pandemic

A study of the impact of the coronavirus disease 2019 (COVID-19) on childhood cancer, published in Cancer, found that the methods by which childhood cancer treatment delivery are approached during crises need to be reassessed, as treatment interruptions and delays are anticipated to affect patient outcomes in this otherwise largely curable disease setting.

Moving forward, the researchers indicated that continued collaborative efforts are needed to better understand the direct and indirect impact of COVID-19.

“Health care system and resource-appropriate modifications are needed to ensure sustained curative outcomes for children with cancer while maintaining their safety and that of their families and health care workers,” the authors wrote. “Assessment of the pandemic regarding access to timely, accurate diagnosis, appropriate curative therapy, and lifesaving supportive care is essential to inform appropriate interventions at the health care system, social support, and advocacy levels during this crisis and to provide readiness for a potential similar future crisis.”

To determine the impact of COVID-19, researchers created a 34-item survey focused on barriers to pediatric oncology management during the pandemic and distributed the survey to the heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Corresponding rates of proven COVID-19 cases and deaths were culminated from the World Health Organization database.

Ultimately, 34 centers across 19 different countries participated in the survey. Overall, the majority of centers were found to have applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use.

“The results indicate that most centers applied policies and guidelines aligned with those recommended by international societies to optimize resource utilization and safety, consistent with other regional single-center reports,” the authors noted.

Essential treatments, including chemotherapy, surgery, and radiation therapy, had to be delayed in 29% to 44% of the centers surveyed, and 24% of centers restricted acceptance of new patients. Additionally, clinical care delivery was also reported as negatively affected in 28% of centers.

Moreover, more than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in less than 30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey.

“The reported blood product and medication shortages point to the potential disruption of lifesaving supportive care,” the authors highlighted. “The survey also confirmed an effect of families’ fear of exposure to COVID-19, barriers to travel (including halted public transport), and economic duress (because of the crisis and loss of daily wages) as well as interruptions in social services support, which adds to the impact caused by a compromised health care service.”

Importantly though, researchers identified unexpected positive outcomes of the pandemic, including resilience, innovation, and collaboration spirit, which were all suggested to be helping hospitals and physicians navigate the changing landscape of healthcare delivery. Given this finding, the investigators recommended that efforts moving forward should focus on initiatives to apply lessons learned and be better prepared to meet future similar challenges.

With few centers surveyed within each country, the researchers noted that the generalizability of the current results cannot be entirely ascertained. Furthermore, the survey was only completed by 1 recipient per hospital, and therefore could not be further cross-checked for independent validation.

“Despite these limitations, we believe that the results are meaningful in identifying both objective and subjective measures of the impact of the pandemic and its response on patients, physicians, and the health care system as they relate to pediatric cancer care delivery in countries of different income levels in the region,” the authors concluded.

Reference:

Saab R, Obeid A, Gachi F, et al. Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Pediatric Oncology Care in the Middle East, North Africa, and West Asia Region: A Report From the Pediatric Oncology East and Mediterranean (POEM) Group. Cancer. doi: 10.1002/cncr.33075.