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Observational Study
. 2022 Apr 11;12(4):e054690.
doi: 10.1136/bmjopen-2021-054690.

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Global Health Research Group on Children’s Non-Communicable Diseases Collaborative
Collaborators
Observational Study

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

Global Health Research Group on Children’s Non-Communicable Diseases Collaborative. BMJ Open. .

Abstract

Objectives: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.

Design: A multicentre, international, collaborative cohort study.

Setting: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.

Participants: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.

Main outcome measure: All-cause mortality at 30 days and 90 days.

Results: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001).

Conclusions: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Keywords: paediatric oncology; paediatrics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Location of the 39 countries that had centres participating in this study.
Figure 2
Figure 2
Kaplan-Meier survival curve of patients with paediatric cancer in high-income countries (HICs) and low-income and middle-income countries (LMICs) adjusted for COVID-19 test outcome, MDT decision: anti-cancer therapy and whether the first admission was planned. MDT, multidisciplinary team.
Figure 3
Figure 3
Kaplan-Meier survival curve of patients with paediatric cancer in high-income countries (HICs) and low-income and middle-income countries (LMICs) stratified by COVID-19 positivity.
See this image and copyright information in PMC

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