Care for children with cancer was hit by Covid-19 at more than three-quarters of hospitals around the world, and particularly badly in poorer countries, according to a new study.
The impact on care meant that almost half of the hospitals made fewer new cancer diagnoses than expected, while a third saw a rise in treatments either being delayed by a month or more or not starting at all, according to the first global study of the pandemic’s impact on the sector published in The Lancet Child & Adolescent Health.
Paediatric cancer units closed completely in seven per cent of the 200 hospitals surveyed, or 15 hospitals. Thirteen of them were in lower and middle income countries (LMICs), or 87 per cent, and on average they were closed for 10 days.
Dr Daniel Moreira, from St Jude Children’s Research Hospital in the United States, said the picture was even worse than expected.
“Our findings suggest that Covid-19 has had a greater impact on childhood cancer care globally than single-region studies had suggested, with centres in LMICs particularly hard hit,” he said.
“Hospitals in LMICs were under strain even before the pandemic, with fewer resources and less access to care for children with cancer, so our results seem to reflect the relative strength of different healthcare systems around the world.”
The survey, which gathered responses from 300 clinicians at hospitals in 79 countries during summer 2020, found that the disruptions in LMICs - which represented 83 per cent of the facilities surveyed - were more serious than in richer countries.
Problems including staffing, delays and a lack of beds and personal protective equipment were reported globally. But the effects in LMICs were more pronounced, with chemotherapy shortages and disruptions to radiotherapy, as well as more “treatment abandonment” - the term for delays to starting treatment or treatment not beginning at all.
For example, 40 per cent of hospitals in low income countries reported changes in chemotherapy services due to treatment agent shortages, but only 11 per cent of hospitals in high income countries. Unexpected deaths were also reported in 31 per cent of the low-income settings - where childhood cancer survival rates were already far lower even pre-pandemic - but only eight per cent in richer countries.
Funding cuts were also more common in poorer countries, and the disruptions in care did not seem to be linked to the number of Covid-19 cases a hospital, or country, had, the research found.
However, the authors noted some limitations to the study. It was conducted in English, meaning low-resource settings where staff do not speak the language or are not part of global paediatric oncology networks may not be represented.
There were some small positives reported among the generally gloomy picture: for example, almost two-thirds of hospitals put in place new processes for communicating with patients and families, which many said could be beneficial post-pandemic.
Professor Laila Hessissen, of Mohammed V University, Morocco, said: “Although the Covid-19 pandemic has created additional barriers to childhood cancer care, we have proven we are a resilient community and can translate some of the adaptations forced by the pandemic to the future of cancer care.”
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