Global Impact of the COVID-19 Pandemic on Paediatric Cancer Care

Background: While mortality due to COVID-19 infection has been reportedly low among paediatric oncology patients, changes in healthcare services due to the pandemic have impacted cancer care delivery. This study assessed the effect of the COVID-19 pandemic on childhood cancer care worldwide. Methods: A cross-sectional survey was distributed to paediatric oncology providers from June to August 2020. The survey included questions to assess institution characteristics, the number of patients diagnosed with COVID-19, and disruptions and adaptations to cancer care. Responses were analysed at the institutional level. Findings: The survey was completed by 311 healthcare professionals at 213 institutions in 79 countries. Most centres had the capacity to test for SARS-CoV-2 (88%) and a median of two infections (range: 0-350) reported in children with cancer. Seven percent of centres reported complete closure of paediatric haematology-oncology services (median ten days). Overall, 43% of centres reported fewer than expected paediatric cancer diagnoses and 34% reported increased treatment abandonment. Institutions described reductions in clinical staff (66%) and decreased financial support (32%). Changes to cancer care delivery included: reduced surgical care (79%), blood product shortages (60%), chemotherapy modifications (55%), and interruptions to radiotherapy (40%). The decreased number of new cancer diagnoses did not vary based on country income status (p=0.1). However, lack of chemotherapy, treatment abandonment, and blood product shortages were more frequent in low- and middle-income countries (p=0.022; p<0.001; p=0.021, respectively). These findings did not vary based on institutional or national number of COVID-19 cases. Hospitals reported new or adapted checklists (68%), processes for communication (63%), and guidelines for essential services (56%) as a result of the pandemic. Interpretation: The COVID-19 pandemic has considerably impacted the care of paediatric oncology patients worldwide, posing significant disruptions to cancer diagnosis and management. While paediatric cancer care has been affected globally, this impact is more pronounced in low-and middle-income countries. Funding Statement: This work was supported by the American Lebanese Syrian Associated Charities (ALSAC). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was exempted by the institutional review board at St. Jude Children’s Research Hospital.