The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review

Amna Majeed; Tom Wright; Biqi Guo; Ramandeep S Arora; Catherine G Lam; Alexandra L Martiniuk

doi:10.3389/fonc.2022.869752

The Global Impact of COVID-19 on Childhood Cancer Outcomes and Care Delivery - A Systematic Review

Front Oncol. 2022 Apr 7:12:869752. doi: 10.3389/fonc.2022.869752. eCollection 2022.

Authors

Amna Majeed¹, Tom Wright², Biqi Guo², Ramandeep S Arora³, Catherine G Lam⁴, Alexandra L Martiniuk²

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
³ Department of Medical Oncology, Max Super-Specialty Hospital, New Delhi, India.
⁴ Department of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States.

Abstract

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.

Keywords: COVID-19; LMIC; global health; health systems and services; healthcare delivery; pediatric clinical outcomes; pediatric oncology.

Publication types

Systematic Review