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The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review
Amna Majeed1, Tom Wright2, Biqi Guo2
1Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Insights
The COVID-19 pandemic disrupted childhood cancer care globally, causing treatment delays and diagnosis interruptions. These impacts were disproportionately severe in low- and middle-income countries (LMICs), highlighting critical global health disparities.
Area of Science:
- Global Health
- Pediatric Oncology
- Infectious Diseases
Background:
- Childhood cancer is a major global health concern, significantly impacting both high-income countries (HICs) and low- and middle-income countries (LMICs).
- The COVID-19 pandemic is suspected to have impeded the progress of pediatric oncology care worldwide.
- This systematic review investigates the worldwide effects of the COVID-19 pandemic on pediatric cancer clinical outcomes and care delivery.
Approach:
- A comprehensive systematic search was conducted across major databases (PubMed, Embase, Medline, African Medical Index) up to November 3, 2021.
- PRISMA guidelines were followed, supplemented by a manual search to ensure inclusion of all relevant studies.
- Eligibility criteria were predefined to ensure the quality and relevance of selected articles.
Key Points:
- While many patients with cancer and COVID-19 were asymptomatic or presented with common symptoms like fever and respiratory issues, crude mortality rates were higher in LMICs (8.0%) compared to HICs (1.8%).
- The pandemic led to significant delays and interruptions in childhood cancer diagnoses and treatments in both HICs and LMICs.
- LMICs experienced disproportionately greater challenges, including staff shortages, supply chain disruptions, and limited access to essential cancer therapies.
Conclusions:
- The COVID-19 pandemic has demonstrably delayed and interrupted childhood cancer therapies and diagnoses, with LMICs bearing a heavier burden.
- This review offers valuable lessons for managing future global health crises and improving pediatric cancer care delivery.
- Key insights are provided to enhance care strategies during the ongoing pandemic and beyond.
Background:
Childhood cancer represents a leading cause of death and disease burden in high income countries (HICs) and low-and-middle income countries (LMICs). It is postulated that the current COVID-19 pandemic has hampered global development of pediatric oncology care programs. This systematic review aimed to comprehensively review the global impact of COVID-19 on childhood cancer clinical outcomes and care delivery.
Methods:
A systematic search was conducted on PubMed, Embase, Medline, and the African Medical Index from inception to November 3, 2021 following PRISMA guidelines. A manual search was performed to identify additional relevant studies. Articles were selected based on predetermined eligibility criteria.
Findings:
The majority of studies reported patients with cancer and COVID-19 presenting as asymptomatic (HICs: 33.7%, LMICs: 22.0%) or with primary manifestations of fever (HICs: 36.1%, LMICs: 51.4%) and respiratory symptoms (HICs: 29.6%, LMICs: 11.7%). LMICs also reported a high frequency of patients presenting with cough (23.6%) and gastrointestinal symptoms (10.6%). The majority of patients were generally noted to have a good prognosis; however the crude mortality rate was higher in LMICs when compared to HICs (8.0% vs 1.8%). Moreover, the pandemic has resulted in delays and interruptions to cancer therapies and delays in childhood cancer diagnoses in both HICs and LMICs. However, these findings were disproportionately reported in LMICs, with significant staff shortages, supply chain disruptions, and limited access to cancer therapies for patients.
Conclusions:
The COVID-19 pandemic has resulted in delays and interruptions to childhood cancer therapies and delays in childhood cancer diagnoses, and disproportionately so within LMICs. This review provides lessons learned for future system-wide disruptions to care, as well as provides key points for moving forward better with care through the remainder of this pandemic.
Systematic Review Registration:
CRD42021266758, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=266758.
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