Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Abstract

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001).ConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Impact of the COVID‐19 pandemic on paediatric renal tumour presentation and management, a SIOP renal tumour study group study

“…42 However, it has been shown that there is a difference between high income countries and low and middle income countries regarding COVID-19-related delay in treatment. 28 We showed that generally, treatment (including surgery) according to the UMBRELLA protocol was feasible without much delay. Previous studies reported shortage of staff and healthcare facilities as a reason for delay in management of patients with cancer.…”

“…[26][27][28] The latter was especially the case in low and middle income countries, where delay and shortage of material and personnel played a larger role than in high income countries. 28 The aforementioned reports reflect mostly either adult cancer and/or national cancer registry perspectives. Therefore, the possibility to ascertain the impact on individual cancer types and organisation of care for subsets of patients on a global scale is still limited.…”

Impact of the COVID-19 on the surgical management of bone and soft tissue sarcoma: A systematic review

“…Study centers were distributed throughout the continents, with several involving international multicenter and conducted by collaborating authors. 1 , 10 , 11 We provide geographical distribution of studies included in this review ( Fig. 2 ).…”

“…Mainly through delay of treatment and centralization of resources, the pandemic have impacted the already-poor outcome of cancer patients especially in low-middle income countries and up to fifteen-fold worsened mortality rate compared to the pre-pandemic data. 11 Regulations and policies made by the higher-ups of contributing sectors within a country should take into account the burden of co-morbidities and other diseases that may concur with sarcoma. 1 …”

“…Distance related to travel restrictions and fear of transmitting COVID-19 became some of the most common obstacles stood between sarcoma patients and their planned treatment. 1 , 11 , 20 , 30 …”