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5 March, 2021

With thanks to Gloal Health Now. Citation, summary and comment from me below.

Dear CHIFA and HIFA,

'Childhood cancer treatments are being sidelined as hospitals prioritize COVID-19 patients and travel restrictions delay diagnoses - particularly in low- and middle-income countries, a global survey found; some facilities reported complete closure of pediatric oncology services. The Lancet Child & Adolescent Health'

CITATION: Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study

Dylan Graetz et al.

Published: March 03, 2021 DOI:https://doi.org/10.1016/S2352-4642(21)00031-6



Background: Although mortality due to COVID-19 has been reportedly low among children with cancer, changes in health-care services due to the pandemic have affected cancer care delivery. This study aimed to assess the effect of the COVID-19 pandemic on childhood cancer care worldwide.

Methods: A cross-sectional survey was distributed to paediatric oncology providers worldwide from June 22 to Aug 21, 2020, through the St Jude Global Alliance and International Society for Paediatric Oncology listservs and regional networks...

Findings: Responses from 311 health-care professionals at 213 institutions in 79 countries from all WHO regions were included in the analysis. 187 (88%) of 213 centres had the capacity to test for SARS-CoV-2 and a median of two (range 0–350) infections per institutution were reported in children with cancer. 15 (7%) centres reported complete closure of paediatric haematology-oncology services (median 10 days, range 1–75 days). Overall, 2% (5 of 213) of centres were no longer evaluating new cases of suspected cancer, while 43% (90 of 208) of the remaining centers described a decrease in newly diagnosed paediatric cancer cases. 73 (34%) centres reported increased treatment abandonment (ie, failure to initiate cancer therapy or a delay in care of 4 weeks or longer). Changes to cancer care delivery included: reduced surgical care (153 [72%]), blood product shortages (127 [60%]), chemotherapy modifications (121 [57%]), and interruptions to radiotherapy (43 [28%] of 155 institutions that provided radiotherapy before the pandemic). The decreased number of new cancer diagnoses did not vary based on country income status (p=0·14). However, unavailability of chemotherapy agents (p=0·022), treatment abandonment (p<0·0001), and interruptions in radiotherapy (p<0·0001) were more frequent in low-income and middle-income countries than in high-income countries. These findings did not vary based on institutional or national numbers of COVID-19 cases. Hospitals reported using new or adapted checklists (146 [69%] of 213), processes for communication with patients and families (134 [63%]), and guidelines for essential services (119 [56%]) as a result of the pandemic.

Interpretation: The COVID-19 pandemic has considerably affected paediatric oncology services worldwide, posing substantial disruptions to cancer diagnosis and management, particularly in low-income and middle-income countries. This study emphasises the urgency of an equitably distributed robust global response to support paediatric oncology care during this pandemic and future public health emergencies.

COMMENT (NPW): In our discussion on HIFA we have been exploring questions around maintaining essential health services, notably "Q3. What have you, your health facility or country done to maintain essential health services?". This paper provides a glimpse in relation to this question, although further details would be welcome:

'Although the effect of the pandemic has been devastating and widespread, health-care systems and providers have demonstrated resilience in response to these challenges. Institutions worldwide have implemented new policies, created checklists, and redistributed resources and staff to battle the pandemic. In our study, institutions reported new use of technology, improved practices around infection control, reprioritisation of the psychosocial needs of families and staff, and care transition to outpatient settings to allow for continued care delivery despite the pandemic. These adaptations, resulting from necessity, often led to the optimisation of existing resources, and might persist beyond the pandemic, resulting in long-lasting improvements in childhood cancer care. These insights should be used to plan for future health emergencies.'

I have invited the authors to join us.


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Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org