TY - JOUR
T1 - Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries
T2 - a multicentre, international, observational cohort study
AU - Global Health Research Group on Children's Non-Communicable Diseases Collaborative
AU - Abdelhafeez, Hafeez
AU - Wilson, Shaun
AU - Nagras, Sonal
AU - Sheth, Mihir
AU - Dominic, Catherine
AU - Gandhi, Suraj
AU - Parwani, Divya
AU - Raj, Rhea
AU - Munezero, Diella
AU - Dutta, Rohini
AU - Roseline, Nsimire Mulanga
AU - McClafferty, Kellie
AU - Nazari, Armin
AU - Sriram, Smrithi
AU - Pillarisetti, Sai
AU - Nweze, King David
AU - Ashwinee, Aishwarya
AU - Kalra, Gul
AU - Patil, Poorvaprabha
AU - Nathani, Priyansh
AU - Bhullar, Khushman Kaur
AU - Elhadi, Muhammed
AU - Khan, Maryam
AU - Rahim, Nehal
AU - Madhusudanan, Shweta
AU - Erhabor, Joshua
AU - Shirke, Manasi
AU - Mughal, Aishah
AU - Au, Darica
AU - Salehi, Mahan
AU - Royyuru, Sravani
AU - Ahmed, Mohamed
AU - Hussain, Syeda Namayah Fatima
AU - Robinson, Daniel
AU - Casey, Anna
AU - Khan, Mehdi
AU - Dukundane, Alexandre
AU - Festus, Kwizera
AU - Govind, Vaishnavi
AU - Pancharatnam, Rohan
AU - Ochieng, Lorraine
AU - Taylor, Elliott H.
AU - Nautiyal, Hritik
AU - De Andres Crespo, Marta
AU - Charuvila, Somy
AU - Valetopoulou, Alexandra
AU - Adhnon, Arshiya
AU - Rana, Asim Noor
AU - Humad, Hani
AU - Madasu, Anjan
N1 - Publisher Copyright:
©
PY - 2022/4/11
Y1 - 2022/4/11
N2 - Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. Design A multicentre, international, collaborative cohort study. Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. Main outcome measure All-cause mortality at 30 days and 90 days. Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). Conclusions The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.
AB - Objectives Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. Design A multicentre, international, collaborative cohort study. Setting 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. Participants Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. Main outcome measure All-cause mortality at 30 days and 90 days. Results 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). Conclusions The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.
KW - paediatric oncology
KW - paediatrics
KW - public health
UR - https://www.scopus.com/pages/publications/85143526998
U2 - 10.1136/bmjopen-2021-054690
DO - 10.1136/bmjopen-2021-054690
M3 - Article
C2 - 35410925
AN - SCOPUS:85143526998
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 4
M1 - 054690
ER -
SDG 3 Good Health and Well-being
SDG 10 Reduced Inequalities