Multicentre service evaluation of presentation of newly diagnosed cancers and type 1 diabetes in children in the UK during the COVID-19 pandemic

Abstract

BackgroundThe COVID-19 pandemic led to changes in patterns of presentation to emergency departments. Child health professionals were concerned that this could contribute to the delayed diagnosis of life-threatening conditions, including childhood cancer (CC) and type 1 diabetes (T1DM). Our multicentre, UK-based service evaluation assessed diagnostic intervals and disease severity for these conditions.MethodsWe collected presentation route, timing and disease severity for children with newly diagnosed CC in three principal treatment centres and T1DM in four centres between 1 January and 31 July 2020 and the corresponding period in 2019. Total diagnostic interval (TDI), patient interval (PI), system interval (SI) and disease severity across different time periods were compared.ResultsFor CCs and T1DM, the route to diagnosis and severity of illness at presentation were unchanged across all time periods. Diagnostic intervals for CCs during lockdown were comparable to that in 2019 (TDI 4.6, PI 1.1 and SI 2.1 weeks), except for an increased PI in January–March 2020 (median 2.7 weeks). Diagnostic intervals for T1DM during lockdown were similar to that in 2019 (TDI 16 vs 15 and PI 14 vs 14 days), except for an increased PI in January–March 2020 (median 21 days).ConclusionsThere is no evidence of diagnostic delay or increased illness severity for CC or T1DM, during the first phase of the pandemic across the participating centres. This provides reassuring data for children and families with these life-changing conditions.

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

“…Any delay in diagnosing life-threatening childhood diseases such as complicated diabetes with severe DKA must be seen as a wake-up call for national health systems. In a recent study (16), there was no evidence of a delay in the diagnosis or increased disease severity for cancers or type 1 diabetes during the first wave of the COVID-19 pandemic in centers in the UK. Therefore, any delays in diagnosing diabetes are heterogeneous according to individual contexts and geography.…”

Pediatric COVID-19 and Diabetes: An Investigation into the Intersection of Two Pandemics

“…Surprisingly, compared to the same period in 2019, the results in 2020 showed a reduction of approximately 20% in new diabetes cases. Similar situations were noticed both in India and the UK [47,48]. A possible explanation would be that along with the lockdown, children were less exposed to seasonal viruses, which are known to be triggers for new-onset type 1 diabetes cases [49,50].…”

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study

“…However, studies have found no significant impact on route to diagnosis and severity of presentation for type 1 diabetes and new diagnosed cancers, as well as no impact on overall outcomes for asthma, pyloric stenosis and appendicitis. [10][11][12][13][14] There have also been concerns that some CYP were unable to access specialist services in hospitals. For example, a study of radiology outpatient activity at a tertiary children's hospital from March 2020 to March 2021 showed a reduction of 27.3%.…”