Abstract
Background: The
ongoing COVID-19 pandemic strained medical systems worldwide. We report
on the impact on pediatric oncology care in Latin American (LATAM)
during its first year.
Method : Four cross-sectional surveys were electronically
distributed among pediatric onco-hematologist in April/June/October
2020, and April/2021 through the Latin American Society of Pediatric
Oncology (SLAOP) email list and St Jude Global regional partners.
Results : 453 pediatric onco-hematologists from 20 countries
responded the first survey with subsequent surveys response rates above
85%. More than 95% of participants reported that treatment continued
without interruption for new and active on-going patients, though with
disruptions in treatment availability. During the first three surveys,
respondents reported suspensions of outpatient procedures (54.2%), a
decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem
cell transplants (SCT) (69.3%), and surveillance consultations
(81.2%). Logistic regression analysis showed that at the beginning of
the first wave, participants from countries with healthcare expenditure
below 7% were more likely to report a decrease in outpatient procedures
(OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and
radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance
consultations was higher in countries with COVID-19 case fatality rates
above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with
COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48,
95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave
with COVID-19 cases rising exponentially, most participants reported
improvements in cancer services availability.
Conclusion : Our data show the medium-term collateral effects of
the pandemic on pediatric oncology care in LATAM, which might help
delineate oncology care delivery amid current and future challenges
posed by the pandemic.
Introduction :
Severe acute respiratory virus (SARS-CoV-2) outbreak resulting in
Coronavirus 2019 disease (COVID-19) caused an unprecedented pandemic
that led to more than 200 million cases and 4 million deaths around the
world (date August 5, 2021).1 One year into the
pandemic, multiple measures were implemented by governments attempting
to slow the spread of COVID-19 and to ameliorate the burden on their
medical systems.2,3 These included home isolations,
closing borders, schools, nonessential business, and restricting travel
within and between countries. The fear generated by the pandemic
resulted in patients being unable or unwilling to seek medical
care.4 The Pandemic exposed unprepared health care
systems with limited personal protective equipment (PPE), limited ICU
staff and ventilators which affected unprotected vulnerable
populations.5 Initial cases of COVID-19 occurred in
Latin America weeks after Europe and North America struggled with a
steep first wave. This allowed Latin American countries to implement
early epidemiological actions and pre-emptively restrict their medical
system’s nonessential use. Now, more than a year into the pandemic, the
resulting economic and social impact are still unfolding. The
development of multiple effective vaccines has provided some relief,
though still only 24.2% of the world population is fully vaccinated,
mainly in HIC6, leaving most of the world exposed to
new waves of COVID-19, with an increased risk for the development of
highly contagious SARS-CoV2 variants.
The survival of pediatric oncology patients depends significantly on a
functional medical system that allows for early diagnosis and referrals
to tertiary care centers, timely initiation, coordination of care among
multidisciplinary teams, and access to supportive
care.7 Early studies showed that complications and
mortality from COVID-19 were lower in pediatric patients compared to
adults,8 and that pediatric oncology patients were not
at elevated risk of poor outcomes as adults cancer
patients.9–11 However, a recent global study
reporting the outcome of pediatric oncologic patients infected with
COVID-19 from April 2020 to February 2021, showed that one-fifth of that
population had a severe critical infection, and 3.8% died due to
COVID-19, which is four times the mortality reported in the pediatric
general population.12
A first report on the pandemic’s impact on pediatric cancer care
delivery in Latin America was published in April 2020 (before the first
wave in the region). This study revealed that healthcare expenditure
(HCE) was closely associated with higher proportions of disrupted
pediatric oncologic treatments.13 However, as the
pandemic evolved, Latin America became one of the world’s hot spots,
accounting for more than 30 million cases and more than 1 million
deaths. This study provides evidence from four cross-sectional surveys
conducted throughout the first year of the pandemic in Latin America,
aiming to show how pediatric cancer services adapted to several waves of
SARS-CoV2 infection and the disruptions of pediatric oncologic care
delivery that resulted from them.
Methods