Impact of the COVID-19 pandemic on pediatric oncology providers globally: A mixed-methods study

Abstract

Background: Coronavirus disease 2019 (COVID-19) disrupted pediatric oncology care globally, increasing demands on health care providers (HCPs) who adapted to continue care. This study sought to characterize the pandemic's impact on pediatric oncology HCPs worldwide.

Methods: A 60-item survey focused on changes to clinical care, resources, and effects on clinicians. A diverse subgroup of institutions was purposefully selected for focus groups that explored teamwork, communication, and changes to care delivery.

Results: The survey included 311 responses from 213 institutions representing 79 countries. Sixteen institutions participated in 19 multidisciplinary focus groups in 8 languages. Decreased clinical staff availability was cited by 51% of institutions as a major impact. Staffing modifications included decreased provider availability (66% of institutions), roles or responsibility changes, and transfer outside the specialty. Physical effects included frequent COVID-19 illness; 8% of respondents reported HCP deaths. Fifty percent of providers did not have the necessary personal protective equipment. HCPs also experienced psychological distress and financial concerns. Findings indicated more frequent impact on nurses than other providers. Impacts were described across all hospital resource levels, with staffing modifications more frequent in countries with higher COVID-19 incidence (P < .001) and mortality rate (P = .004). Focus groups revealed negative impacts were stabilized by increased teamwork, communication, contributions outside usual roles, policies aimed at optimizing safety, and feeling that they were contributing.

Conclusions: COVID-19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological, and financial distress. Despite these challenges, HCPs caring for children with cancer came together to continue to provide high-quality care.

Keywords: coronavirus disease 2019 (COVID-19); delivery of health care; global; health care personnel; pediatric oncology; workforce.

Figure 1

Survey respondents and focus‐group institutions. Countries represented by survey respondents (green, categorized by country income classification) and focus groups. Responses were received from 79 countries; focus groups were held in 16 countries.

Figure 2

Coronavirus disease 2019 (COVID‐19) had a major impact on the care of children with cancer. The frequency of responses of the main source of effects of the COVID‐19 pandemic on pediatric cancer care (n = 213) are shown.

Figure 3

Pediatric hematology/oncology staff reassignment by provider type: quantitative and qualitative results. (A) Frequency of reassignment of hematology/oncology physicians and nurses as reported by survey respondents (n = 213). (B) Representative quotes describing the reassignment of providers.