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

Abstract

Background Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID‐19) pandemic on access to care for children with cancer is likely but has not been evaluated. METHODS A 34‐item survey focusing on barriers to pediatric oncology management during the COVID‐19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID‐19 cases and deaths were retrieved from the World Health Organization database. Results In total, 34 centers from 19 countries participated. Almost all centers 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. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater 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 <30% of centers, reflecting the low rates of COVID‐19 hospitalizations in the corresponding countries at the time of the survey. Conclusions Mechanisms to approach childhood cancer treatment delivery during crises need to be re‐evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.

Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study

“…Paediatric oncology care is reliant on prompt evaluation and diagnosis, referral to tertiary centres, multidisciplinary subspecialised teams, timely and coordinated multimodal therapy, and access to supportive care, all of which have been affected by this pandemic. 9 , 10 , 11 …”

The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review

“…In particular, most of the included papers were letters to the editor ( n = 5; 23.8%) [ 26 , 27 , 28 , 29 , 30 ] or recommendations (guidelines or expert consensus) ( n = 5; 23.8%) [ 31 , 32 , 33 , 34 , 35 ]. The other papers were three correspondences [ 6 , 36 , 37 ], two reviews [ 38 , 39 ], two surveys [ 9 , 40 ], two commentaries [ 41 , 42 ], and two editorials [ 43 , 44 ].…”

“…There is still controversy as to whether chemotherapy should be delayed in asymptomatic COVID-19 patients due to the current absence of evidence that chemotherapy may result in further harm for these patients [ 9 , 38 ]. There are articles that include more stringent measures regarding the possibility of continuing or initiating specific anticancer treatment [ 36 , 37 , 39 , 40 ]. In particular, Wu Xiaoyan et al (2020) recommend immediately interrupting chemotherapy in the event that a pediatric patient is positive for COVID-19, whether they are with or without symptoms.…”

“…Some articles included recommendations on when to administer other types of treatment, such as radiotherapy or surgery. Radiotherapy did not substantially affect the immune system; therefore, its continuation is recommended [ 26 , 28 , 32 , 35 , 36 , 40 , 45 ]. On the other hand, for surgery, patients that are suspected to be or are COVID-19-positive have to be transferred to units that are appropriate for pre-operative treatment and then be taken to the operating room through specially dedicated pathways [ 32 , 33 , 35 , 36 , 39 , 40 ].…”

Teleconsultations and Shared Care in Pediatric Oncology During COVID-19

“…With healthcare centres throughout the world grappling with COVID-19 pandemic with resource optimization, all aspects of cancer treatment were adversely affected, including ancillary services like blood product availability [ 2 ]. Drawing on the early experience in Italy, a consensus based guideline was formulated by International Childhood Cancer Organizations to adapt treatment strategy of childhood cancer patients keeping in mind resource limitations during the pandemic [ 3 ].…”