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

Abstract

BackgroundChildhood cancer represents a leading cause of death and disease burden in high income countries (HICs) and low-and-middle income countries (LMICs). It is postulated that the current COVID-19 pandemic has hampered global development of pediatric oncology care programs. This systematic review aimed to comprehensively review the global impact of COVID-19 on childhood cancer clinical outcomes and care delivery.MethodsA systematic search was conducted on PubMed, Embase, Medline, and the African Medical Index from inception to November 3, 2021 following PRISMA guidelines. A manual search was performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria.FindingsThe majority of studies reported patients with cancer and COVID-19 presenting as asymptomatic (HICs: 33.7%, LMICs: 22.0%) or with primary manifestations of fever (HICs: 36.1%, LMICs: 51.4%) and respiratory symptoms (HICs: 29.6%, LMICs: 11.7%). LMICs also reported a high frequency of patients presenting with cough (23.6%) and gastrointestinal symptoms (10.6%). The majority of patients were generally noted to have a good prognosis; however the crude mortality rate was higher in LMICs when compared to HICs (8.0% vs 1.8%). Moreover, the pandemic has resulted in delays and interruptions to cancer therapies and delays in childhood cancer diagnoses in both HICs and LMICs. However, these findings were disproportionately reported in LMICs, with significant staff shortages, supply chain disruptions, and limited access to cancer therapies for patients.ConclusionsThe COVID-19 pandemic has resulted in delays and interruptions to childhood cancer therapies and delays in childhood cancer diagnoses, and disproportionately so within LMICs. This review provides lessons learned for future system-wide disruptions to care, as well as provides key points for moving forward better with care through the remainder of this pandemic.Systematic Review RegistrationCRD42021266758, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266758

Type of cancer and complementary and alternative medicine are determinant factors for the patient delay experienced by children with cancer: A study in West Java, Indonesia

“…However, still, some of the parents are reluctant to use healthcare facilities as their primary attempt due to negative parental perceptions regarding the quality of healthcare and national insurance. Our additional finding from qualitative data found that COVID‐19 pandemic affected healthcare facility accessibility due to lockdown and lack of family and community support groups 64 …”

“…Our additional finding from qualitative data found that COVID-19 pandemic affected healthcare facility accessibility due to lockdown and lack of family and community support groups. 64 Certain limitations of this study need to be addressed. First, the cross-sectional study design may have potentially biased our results because of wide confounding factors, such as the high proportion of nonresponder subjects and recall bias.…”

Changes in cancer prevention and management and patient needs during the COVID-19 pandemic: An umbrella review of systematic reviews

“…In addition, differences were observed by geographical area, suggesting that the impact on cancer treatment, screening and diagnosis could depend on mitigation strategies countries implemented as well as on country-specific health care organization and resources. For example, shortage of treatment and delays and interruptions to cancer therapies in general were more pronounced in low-and middle-income countries 14 . The findings on disruption of cancer treatment, screening and diagnosis are in line with findings reported for other chronic diseases, such as cardiovascular disease 52 , suggesting the adverse impact might not be cancer specific.…”

“…Lignou S et al 2022 38 reported that between 18 th to 31 st of January 2021, pediatric and noncancer surgical activities were occurring at less than a third of the rate of the previous year, while Di Cosimo SD et al 2022 34 reported cancellation/delays of treatment in 58% (95%CI, 48%-67%; I 2 , 98%) of centers. Majeed A et al, 2022 14 showed that shortage of treatment and delays and interruptions to cancer therapies in general were more common in low-and middle-income countries.…”

The Impact of COVID-19 on Pediatric Malignancy Diagnosis and Treatment: Never the Same but Lessons Learned

“…The coronavirus disease 2019 (COVID-19) has caused tremendous strain on the healthcare systems worldwide and has captivated the interest of pediatric oncologists in a unique way. Adults with COVID-19 were reported to have a severe course of disease with a significantly higher mortality rate [ 2 ]. However, we now have data to show that most of the children who tested positive for COVID-19 had either asymptomatic infection or mild symptoms, with only a handful presenting with severe disease requiring critical care [ 3 ].…”