Caring for Children with Cancer in Africa during the COVID-19 Crisis: Implications and Opportunities

Abstract

Africa has been here before! The human immunodeficiency virus (HIV) epidemic ravaged across most of the continent. Then, the regional outbreaks of the very transmissible and fatal Ebola virus. Now, a new and highly infectious organism again threatens the continent as well as the entire world. The coronavirus disease that emerged in late 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to a worldwide pandemic. It has also created an environment where children with cancer and blood disorders in low and middle-income countries (LMICs) across the globe, such as in Africa, may now have even less access to care than before. This epidemic compounds one of the greatest global health care tragedies-the disparity where 80% of children with cancer living in LMICs succumb to their disease compared to over 80% survival for childhood cancer patients in the United States and other high income countries (HICs). 1 The public health emergency created by COVID-19 has created a seismic shift in health care priorities and focus. Examples abound in HICs of individuals with chronic noncommunicable diseases (NCDs) being restricted access to vital medical care as a result of the ripple effects of the COVID pandemic. 2 Due to the collateral damage of COVID-19, it has been estimated that a 5-10% decrease in cancer survival will occur in adults with cancer in HICs. 3 It is impossible to know to what degree, but it can be assumed that the impact in LMICs will be even more significant. Children's access to health care as well as food is predicted to be impacted by the pandemic. 4 Health systems in Africa, already suffering from a lack of resources and sound infrastructure to appropriately address NCDs, may be pushed to the brink by the demands to meet this gripping pandemic. Even before COVID-19, cancer care in Africa faced many challenges that are only being exacerbated by this new pandemic. 5 To avoid

Quality of life and occupational performance of children with cancer in the era of the COVID-19 pandemic in terms of rehabilitation

“…Besides the negative effects of the pandemic period on children's participation and mental health, parents stated this period increased the empathy of healthy individuals. Although this finding has a positive effect on mental health, it will not be enough to ignore the wide range of negative effects of the pandemic such as deterioration in the health system, changes in treatment routines, travel restrictions, social isolation, and loss of income [54].…”

Cancer Care During the COVID-19 Pandemic: The African Narrative and Prospects

“…Whilst children have a low predisposition to coming down with the coronavirus disease and its complications, the public health regulations that were put in place against the pandemic have had an attendant effect on the diagnosis and treatment of cancer amongst the pediatric populace in many African countries [ 41 , 42 ]. These have been worsened by inadequate financial allocations to healthcare, paucity of appropriately trained medical personnel, non-availability of laboratories, delay in cancer surgeries, rescheduling of radiotherapy, non-standard alteration to chemotherapy regimens due to shortages in anticancer medications, blood products scarcity, difficulty accessing health care, inability to afford investigations and treatments and attend follow-up [ 10 , 16 , 43 ]. Almost 60% of pediatric oncologists involved in a transverse study carried out from 1st to 15th May 2020, involving 15 countries spanning the five regions of Africa indicate that the coronavirus pandemic has had a deleterious effect on the management of the top six childhood malignancies indexed in the World Health Organizations Global Initiative for Childhood Cancers [ 10 ].…”

“…Almost 60% of pediatric oncologists involved in a transverse study carried out from 1st to 15th May 2020, involving 15 countries spanning the five regions of Africa indicate that the coronavirus pandemic has had a deleterious effect on the management of the top six childhood malignancies indexed in the World Health Organizations Global Initiative for Childhood Cancers [ 10 ]. Since the onset of the pandemic, children have continued to suffer from advanced local and metastatic disease and quite a number of them have not been offered effective treatment to date [ 43 ].…”

Management of Covid-19 Disease in Pediatric Oncology Patients

“…Cancer diagnosis, treatment, palliative care, hospital visits are interrupted because of the pandemic. Another concern is delayed cancer diagnosis, chemotherapy shortages, decreased availability of surgery, radiotherapy, supportive treatment, inadequate personal productive equipment, and drugs, especially in lowmiddle income countries [9,10]. The most common cancer in the pediatric population is acute leukemia.…”