Abstract
Background: The ongoing COVID-19 pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year.
Method : Four cross-sectional surveys were electronically distributed among pediatric onco-hematologist in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners.
Results : 453 pediatric onco-hematologists from 20 countries responded the first survey with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active on-going patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48, 95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability.
Conclusion : Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.
Introduction :
Severe acute respiratory virus (SARS-CoV-2) outbreak resulting in Coronavirus 2019 disease (COVID-19) caused an unprecedented pandemic that led to more than 200 million cases and 4 million deaths around the world (date August 5, 2021).1 One year into the pandemic, multiple measures were implemented by governments attempting to slow the spread of COVID-19 and to ameliorate the burden on their medical systems.2,3 These included home isolations, closing borders, schools, nonessential business, and restricting travel within and between countries. The fear generated by the pandemic resulted in patients being unable or unwilling to seek medical care.4 The Pandemic exposed unprepared health care systems with limited personal protective equipment (PPE), limited ICU staff and ventilators which affected unprotected vulnerable populations.5 Initial cases of COVID-19 occurred in Latin America weeks after Europe and North America struggled with a steep first wave. This allowed Latin American countries to implement early epidemiological actions and pre-emptively restrict their medical system’s nonessential use. Now, more than a year into the pandemic, the resulting economic and social impact are still unfolding. The development of multiple effective vaccines has provided some relief, though still only 24.2% of the world population is fully vaccinated, mainly in HIC6, leaving most of the world exposed to new waves of COVID-19, with an increased risk for the development of highly contagious SARS-CoV2 variants.
The survival of pediatric oncology patients depends significantly on a functional medical system that allows for early diagnosis and referrals to tertiary care centers, timely initiation, coordination of care among multidisciplinary teams, and access to supportive care.7 Early studies showed that complications and mortality from COVID-19 were lower in pediatric patients compared to adults,8 and that pediatric oncology patients were not at elevated risk of poor outcomes as adults cancer patients.9–11 However, a recent global study reporting the outcome of pediatric oncologic patients infected with COVID-19 from April 2020 to February 2021, showed that one-fifth of that population had a severe critical infection, and 3.8% died due to COVID-19, which is four times the mortality reported in the pediatric general population.12
A first report on the pandemic’s impact on pediatric cancer care delivery in Latin America was published in April 2020 (before the first wave in the region). This study revealed that healthcare expenditure (HCE) was closely associated with higher proportions of disrupted pediatric oncologic treatments.13 However, as the pandemic evolved, Latin America became one of the world’s hot spots, accounting for more than 30 million cases and more than 1 million deaths. This study provides evidence from four cross-sectional surveys conducted throughout the first year of the pandemic in Latin America, aiming to show how pediatric cancer services adapted to several waves of SARS-CoV2 infection and the disruptions of pediatric oncologic care delivery that resulted from them.
Methods