The pandemic has hurt everyone, but children and adolescents with cancer more. It has reduced the number of diagnoses and surgeries, or forced to suspend or postpone chemo and radiotherapy. In some cases, especially in the poorest countries where the situation was already complex before the arrival of the Sars-Cov-2 virus, it has emptied the pediatric oncology wards or forced them to close.
This is the picture that shows a survey, the first to analyze globally the effect of the pandemic on the treatment of children’s cancers, conducted on 311 doctors in 213 hospitals spread across 79 countries. 83% of the data collected concerned low- and middle-income countries. The results, obtained through questionnaires, refer to the period from 21 June to 22 August 2020 and are published on Lancet Child & Adolescent Health.
Human and financial resources
The effects of the pandemic on the treatment of pediatric cancers are largely independent of the number of Covid-19 cases counted both at hospital and local level: even where the number of infections was low, health care ended up being compromised because part of the resources in terms of funding and personnel was in any case diverted to the health emergency. Hospitals’ resources were significantly impacted: one third of respondents reported a substantial funding cut, while two thirds (66%) reported a reduction in health care personnel, and in one in five hospitals (19%) there was a reduction in the availability of beds for children with cancer.
The decline in diagnoses and the delay in treatment
Covid-19 impacted 78% of the health facilities that participated in the survey. 43% of the facilities diagnosed fewer cases of pediatric cancers than expected based on numbers from previous years. 34%, or one in three, reported an increase in the number of young patients whose therapy has not started or has been delayed for at least four weeks; 15 pediatric oncology units, including 13 in low- or middle-income countries, closed for an average of 10 days. 79% of the participants reported a reduction in surgery, 60% of a reduced availability of blood and blood products, 57% said they had to postpone chemotherapy due to lack of drugs, 28% said they had to stop the radiotherapy.
The differences between low, middle and high income countries
As is clear, low-income countries pay the highest price. Treatment protocols had to be changed due to lack of drugs in 40-45% of the centers in low- and middle-income countries and in 11% of the facilities in high-income countries. The percentage of neglect of care was 33-52% in the former and 8% in the latter. As for radiotherapy, interruptions occurred in 46-68% and 10% of the structures, respectively. And again: 33 per cent of hospitals in low-income countries saw a reduction in life-saving interventions, 11 times more than in rich countries (3%). “Our results – commented Daniel Moreira, of St. Jude Children’s Research Hospital in Memphis, USA, and co-author of the report – say that Covid-19 has had a greater impact on the treatment of pediatric cancers globally than indicate studies conducted on a single region “. “The definition of hospital priorities for patients with Covid-19, combined with the closure of borders and limited public transport, have contributed to delaying diagnoses – write the authors in Lancet. And after the diagnosis, “the pandemic has made it more difficult to obtain quality care, including inclusion in clinical trials.”
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A resilient community
But how have hospitals and pediatric oncologists reacted? Most developed new guidelines to support child care: more than two thirds (69%) applied new safety rules for staff and young patients, 63% changed their communication systems with children and families, and in many cases the routes of essential services have been redefined. Many of these adaptations have been well received by hospital staff and may be useful even when we are out of this health crisis, according to the authors of the paper ”. “The long-term impacts on pediatric cancer outcomes are still unclear,” said Dylan Graetz, of St. Jude Children’s Research Hospital in Memphis and first author of the study: “Continuous assessment of resource needs is needed. during the pandemic and sharing successful strategies to address the negative effects on pediatric cancer care ”.