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.