A Cross-Sectional Study of Unlocking Childhood Cancer Services during COVID-19 Pandemic: A Pediatric Oncology Tertiary Care Center's Experience from a Developing Country

Abstract

Introduction The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services.

Objective The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic.

Materials and Methods This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic.

Results Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care; $1,144.90 for travel support; and $17,010.94 was waived off by hospital administration to support the poor families.

Conclusion The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.

Keywords

lockdown - interrupted childhood cancer care services - multilevel supportive care model

Ethics

The Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (IEC-NI/21/FEB/77/15(COVID-19)) approved this study. The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1965, as revised in 2013. Informed patient consent was obtained prior to enrolment.

Publication History

Article published online:
02 July 2022

• References

• 1 Liang W, Guan W, Chen R. et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 2020; 21 (03) 335-337
• 2 Boulad F, Kamboj M, Bouvier N, Mauguen A, Kung AL. COVID-19 in children with cancer in New York City. JAMA Oncol 2020; 6 (09) 1459-1460
• 3 Kotecha RS. Challenges posed by COVID-19 to children with cancer. Lancet Oncol 2020; 21 (05) e235
• 4 Sullivan M, Bouffet E, Rodriguez-Galindo C. et al; Contributing Authors. The COVID-19 pandemic: a rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St Jude Global. Pediatr Blood Cancer 2020; 67 (07) e28409
• 5 Chiaravalli S, Ferrari A, Sironi G. et al. A collateral effect of the COVID-19 pandemic: delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer 2020; 67 (10) e28640
• 6 Moreira DC, Millen GC, Sands S, Kearns PR, Hawkins DS. The care of children with cancer during the COVID -19 pandemic. Am Soc Clin Oncol Educ Book 2021; 41: 1-10
• 7 Graetz D, Agulnik A, Ranadive R. et al. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Health 2021; 5 (05) 332-340
• 8 Saab R, Obeid A, Gachi F. et al. 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. Cancer 2020; 126 (18) 4235-4245
• 9 Erdmann F, Wellbrock M, Trübenbach C. et al. Impact of the COVID-19 pandemic on incidence, time of diagnosis and delivery of healthcare among paediatric oncology patients in Germany in 2020: evidence from the German Childhood Cancer Registry and a qualitative survey. Lancet Reg Health Eur 2021; 9: 100188
• 10 Mukkada S, Bhakta N, Chantada GL. et al; Global Registry of COVID-19 in Childhood Cancer. Global characteristics and outcomes of SARS-CoV-2 infection in children and adolescents with cancer (GRCCC): a cohort study. Lancet Oncol 2021; 22 (10) 1416-1426
• 11 Alshahrani M, Elyamany G, Sedick Q. et al. The impact of COVID-19 pandemic in children with cancer: a report from Saudi Arabia. Health Serv Insights 2020; 13 DOI: 10.1177/1178632920984161.
• 12 Mahajan A, Arora RS, Sahi PK. et al. Shared care for children with cancer in India through social and healthcare partnerships during the COVID-19 pandemic. Cancer Rep (Hoboken) 2021; e1486
• 13 Seth R, Das G, Kaur K. et al. Delivering pediatric oncology services during a COVID-19 pandemic in India. Pediatr Blood Cancer 2020; 67 (12) e28519
• 14 Trehan A, Jain R, Bansal D. Oncology care in a lower middle-income country during the COVID-19 pandemic. Pediatr Blood Cancer 2020; 67 (08) e28438
• 15 Balduzzi A, Brivio E, Rovelli A. et al. Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati. Bone Marrow Transplant 2020; 55 (10) 1900-1905