Survey questionnaires
Each survey collected data on the individual perspectives of physicians
(pediatric oncologist, medical directors, residents, and fellows)
working in pediatric onco-hematology departments of public and private
health institutions. Other health care providers, such as nurses,
psychologists, and physical, occupational and speech therapists, among
others were excluded. Each survey contained between 20 and 32 items and
was developed to capture data about the disruption and adaptation of
pediatric cancer care at a specific time point, aiming to detect
changes, as the pandemic evolved.
Questions on the following topics were included: treatment suspension of
newly diagnosed patients and active ongoing cases, chemotherapy protocol
modifications, displacement or reduction of medical staff, suspension of
outpatient procedures, cancer surgeries, radiation therapy sessions,
bone marrow transplantation, and palliative care assessments and care.
In addition, some questions were formulated to capture information about
strategies implemented to provide continuity of care (telemedicine) and
personal perspectives on the greatest impacts of the pandemic on
patients’ care (delays in diagnosis, treatment abandonment, and
out-of-pocket expenses).
Health indicators and epidemiologic parameters of COVID-19, such as
incidence rate, case fatality rate (number of COVID-19 deaths divided by
the total number of cases, multiplied by 100) and healthcare expenditure
as a percentage of GDP (HCE) from each country were analyzed for
potential association with the impact of treatment of children with
cancer. All responses were anonymous and institutional ethical review
was not required. After data collection, each country delegate verified
the authenticity and consistency of the data provided.