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

Abstract

Background: Childhood cancer is a highly curable disease when timely diagnosis and appropriate therapy are provided. A negative impact of the coronavirus disease 2019 (COVID-19) pandemic on access to care for children with cancer is likely but has not been evaluated.

Methods: A 34-item survey focusing on barriers to pediatric oncology management during the COVID-19 pandemic was distributed to heads of pediatric oncology units within the Pediatric Oncology East and Mediterranean (POEM) collaborative group, from the Middle East, North Africa, and West Asia. Responses were collected on April 11 through 22, 2020. Corresponding rates of proven COVID-19 cases and deaths were retrieved from the World Health Organization database.

Results: In total, 34 centers from 19 countries participated. Almost all centers applied guidelines to optimize resource utilization and safety, including delaying off-treatment visits, rotating and reducing staff, and implementing social distancing, hand hygiene measures, and personal protective equipment use. Essential treatments, including chemotherapy, surgery, and radiation therapy, were delayed in 29% to 44% of centers, and 24% of centers restricted acceptance of new patients. Clinical care delivery was reported as negatively affected in 28% of centers. Greater than 70% of centers reported shortages in blood products, and 47% to 62% reported interruptions in surgery and radiation as well as medication shortages. However, bed availability was affected in <30% of centers, reflecting the low rates of COVID-19 hospitalizations in the corresponding countries at the time of the survey.

Conclusions: Mechanisms to approach childhood cancer treatment delivery during crises need to be re-evaluated, because treatment interruptions and delays are expected to affect patient outcomes in this otherwise largely curable disease.

Keywords: care delivery; coronavirus disease 2019 (COVID-19); middle-income countries; pandemic; pediatric oncology.

Figure 1

(A) Membership in the Pediatric Oncology East and Mediterranean (POEM) collaborative group includes practitioners in the countries shown on the map in yellow and red, with red color depicting countries in which centers have completed the survey, and the corresponding number of participating centers. These countries are also listed alphabetically below, with those participating in the survey denoted by asterisks: Afghanistan, *Algeria, *Armenia, *Bahrain, Bangladesh, Egypt, *Georgia, India, *Iran, *Iraq, *Jordan, *Kingdom of Saudi Arabia, *Kuwait, *Lebanon, Libya, *Morocco, *Nepal, *Oman, *Pakistan, *Palestine, Qatar, Sri Lanka, *Sudan, *Syria, Tunis, *Turkey, United Arab Emirates, and *Yemen. (B) The number of POEM countries, stratified by World Bank Income category with corresponding stratification of respondents, and the percentage of respondents with respect to each category are shown. (C) The numbers of confirmed coronavirus disease 2019 (COVID‐19) cases, deaths, and deaths per million population, as reported by the World Health Organization, are shown for each country during the period of the survey. The first number in each cell corresponds to the date of April 11, 2020, and the second to the date of April 23, 2020. HIC indicates high‐income country; LIC, low‐income country; LMIC, lower middle‐income country; UMIC, upper middle‐income country.

Figure 2

(A) The number of centers reporting specific changes in national and hospital policies affecting pediatric oncology care, as detailed; B) the number of patient cancellations of surveillance (off‐treatment ) follow‐up visits; and C) the effect of fear, restrictions in transportation, and economic duress in patient‐driven cancellations of essential treatment visits are illustrated. On‐Rx indicates on medication; XRT, radiation therapy.

Figure 3

The impact of the coronavirus disease 2019 (COVID‐19) pandemic is illustrated on (A) medical staffing resources, as detailed; (B) treatment resources, as detailed; and C) overall treatment delivery according to the number of centers. PICU indicates pediatric intensive care unit.