The Unique Balancing Act of Managing Children With Cancer and COVID-19 Infection: A Single Center Experience From South India

Abstract

Children with cancer are vulnerable to severe infections. Balancing the intensive treatment of cancer, with the potential risk of coronavirus disease-2019 (COVID-19) related morbidity and mortality is a unique challenge. Children with cancer testing positive for severe acute respiratory syndrome coronavirus 2 virus by reversetranscription polymerase chain reaction at our center were studied. Thirty-seven children tested positive for COVID-19 during the study period. The severity of the illness was mild, moderate, severe, and critical in 10 (27%), 13 (35%), 12 (32%), and 2 (5%) patients, respectively. Of the 14 patients with a severe/critical illness, 2 had oncological emergencies, 4 had dengue co-infection, and 1 had an inguinal bacterial abscess. All patients were discharged in a stable condition. Modification of the treatment protocol was performed in 11 (33%) of 33 patients who were on active treatment for cancer. There was a median delay of 32.5 days to administer the next cycle of chemotherapy in patients who acquired COVID-19 during cancer treatment. Six of 7 patients who were retested after 14 days remained positive by reverse-transcription polymerase chain reaction. Children with cancer with COVID-19 recover with good supportive care. Curative chemotherapy can be administered safely with appropriate modifications in children with cancer with COVID-19.

The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review

“…Twenty-four studies were conducted in LMICs, including Armenia (n=1), China (n=1), Mexico (n=1), Turkey (n=2), India (n=10), Iran (n=2), and Pakistan (n=4) ( Appendix B ). Similar to HICs, studies conducted in LMICs reported delays to chemotherapy ( 33 , 54 – 57 ), decrease in surgery rates ( 55 , 58 ), and decline in the number of new diagnoses and supportive care services offered (i.e., palliative care, psychologist, social welfare services, residential supports) ( 59 , 60 ). One comprehensive retrospective chart review by Kutluk and colleagues (2021) noted that in a major Turkish pediatric oncology department, outpatient and inpatient visits were reduced by 29.6% (p<0.0001) from March-October 2020 as compared to an analogous time period before the pandemic ( 61 ).…”

“…(2021) noted that of 2115 children under 15 years old tested for COVID-19 in southern India, 37 patients were positive and had cancer diagnoses. The most common underlying malignancies were ALL (n=16) and Ewing sarcoma (n=7) ( 33 ). While the majority of patients were asymptomatic or had mild/moderate courses of disease (n=23, 62%), 12 patients presented with severe courses of hypoxia, tachypnea, and shock.…”

“…While the majority of patients were asymptomatic or had mild/moderate courses of disease (n=23, 62%), 12 patients presented with severe courses of hypoxia, tachypnea, and shock. Two patients had critical disease and required mechanical ventilation, experiencing shock requiring vasoactive support, andhad organ dysfunction, and/or coagulopathy ( 33 ). The authors postulated that contributing factors to the illness were oncological emergencies (n=2), dengue co-infection (n=4), and inguinal bacterial abscess (n=1).…”

“…The authors postulated that contributing factors to the illness were oncological emergencies (n=2), dengue co-infection (n=4), and inguinal bacterial abscess (n=1). However, all patients were discharged in a stable condition ( 33 ).…”

COVID‐19 outcomes in paediatric cancer: A large scale pooled meta‐analysis of 984 cancer patients

“…We screened a total of 2759 records after transferring the databases results without duplicates. We further assessed 61 full texts for eligibility which ended up with a total of 21 articles including 14 studies and additional seven studies following manual search procedures 7 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 (Figure 1 , Table 1 ).…”