Impact of COVID-19 Pandemic on Delay of Diagnosis and Treatment: Outcomes in Pediatric malignant solid tumors

Abstract

Objective: Restriction of access to healthcare during coronavirus disease 2019 (COVID-19) pandemic is a major problem for patients with cancer. Although childhood cancers are highly curable, it is obvious that diagnostic and treatment disruptions will lead to poor results. In our study, we investigated whether children with newly diagnosed cancer and under treatment were affected by the restrictions and the clinical course and outcomes of patients diagnosed with COVID-19 during cancer treatment. Materials and Methods: We applied a questionnaire consisting of 18 questions to parents. Data were collected from medical files of patients diagnosed with COVID-19 during anticancer treatment. Results: Thirty-five of the patients were newly diagnosed and 55 patients were on-going treatment. Since 13 (38%) of newly diagnosed patients visited the hospital late, cancer diagnosis was delayed. Treatment delay occurred in 9 (16%) of the patients whose receiving chemotherapy. Fifty-eight patients developed COVID-19 infection at different stages of their anticancer treatment. Almost all patients recovered from COVID-19 with mild symptoms. Conclusion: While strict measures are required to control the pandemic, patients with severe critical illness such as cancer should be carefully evaluated and treatment delays that may have vital consequences should be avoided. In pediatric patients with cancer whom infected by COVID-19, continuation of anticancer treatment should be considered by evaluating the clinical status of the patient.

Keywords

• Cancer
• Children
• COVID-19

COVID-19 Pandemisinin Teşhis ve Tedavi Gecikmesine Etkisi: Çocukluk çağı maliyn solid tümör sonuçları

Abstract

Amaç: Koronavirüs hastalığı 2019 (COVID-19) salgını sırasında sağlık hizmetlerine erişimin kısıtlanması, kanserli hastalar için önemli bir sorundur. Çocukluk çağı kanserleri yüksek oranda tedavi edilebilse de tanı ve tedavi aksamalarının kötü sonuçlara yol açacağı aşikardır. Çalışmamızda yeni tanı konulan ve tedavi gören çocukların kısıtlamalardan etkilenip etkilenmediğini ve kanser tedavisi sırasında COVID-19 tanısı alan hastaların klinik seyir ve sonuçlarını araştırdık. Gereç ve yöntemler: Hasta ebeveynlerine 18 sorudan oluşan bir anket uyguladık. Kanser tedavisi sırasında COVID-19 tanısı alan hastaların dosyaları taranarak veriler kaydedildi. Bulgular: Hastaların 35'i yeni tanı grubunda, 55’i ise tedavisi devam eden gruptaydı. Yeni tanı alan hastaların 13'ü (%38) hastaneye geç başvurduğu için kanser tanısı gecikti. Kemoterapi alan hastaların 9'unda (%16) tedavide gecikme yaşandı. Elli sekiz hasta, kanser tedavisinin farklı aşamalarında COVID-19 enfeksiyonu geçirdi. Hastaların tamamına yakını hafif semptomlarla COVID-19'dan iyileşti. Sonuç: Salgını kontrol altına almak için sıkı önlemler alınması gerekirken, kanser gibi ağır kritik hastalığı olan hastalar dikkatle değerlendirilmeli ve hayati sonuçlar doğurabilecek tedavi gecikmelerinden kaçınılmalıdır. Koronavirüs hastalığı 2019 ile enfekte olan kanserli çocuk hastalarda, hastanın klinik durumu değerlendirilerek kanser tedavisine devam edilmesi düşünülmelidir.

Keywords

• COVID-19
• Çocuk
• Kanser

References

1. Del Rio C, Malani PN. COVID-19-New Insights on a Rapidly Changing Epidemic. JAMA 2020;323:1339-40.
2. World Health Organization. Emergency: Coranavirus disease (COVID-19) pandemic. https ://ww w.who .int/ emergencies/diseases /novel-coronavirus-2019
3. Ministry of Health of Turkey. COVID-19 information platform. https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
4. Pérez-Heras I, Fernandez-Escobar V, Del Pozo-Carlavilla M, Díaz-Merchán R, Valerio-Alonso ME, Domínguez-Pinilla N. Two Cases of SARS-CoV-2 Infection in Pediatric Oncohematologic Patients in Spain. Pediatr Infect Dis J 2020;39:1040-2.
5. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 Infection in Children. N Engl J Med 2020;382:1663-5.
6. Chiaravalli S, Ferrari A, Sironi G, Gattuso G, Bergamaschi L, Puma N, et al. A collateral effect of the COVID-19 pandemic: Delayed diagnosis in pediatric solid tumors. Pediatr Blood Cancer 2020;67:e28640.
7. Ding, YY, Ramakrishna S, Long AH, Phillips CA, Montiel-Esparza R, Diorio CJ, et al. Delayed cancer diagnoses and high mortality in children during the COVID-19 pandemic. Pediatr Blood Cancer 2020;67:e28427.
8. Miranda DLP, Nogueira-Rodrigues A, Fagundes TP, Albuquerque RM, Landeiro LCG. COVID-19 threatens to cause collateral delay in cancer diagnosis. Sao Paulo Med J 2020;138:347-8.

9. Molica M, Mazzone C, Cordone I, Pasquale A, Niscola P, de Fabritiis P. SARS-CoV-2 infection anxieties and general population restrictions delay diagnosis and treatment of acute haematological malignancies. Br J Haematol 2020;190:e5-e8.
10. Carai A, Locatelli F, Mastronuzzi A. Delayed referral of pediatric brain tumors during COVID-19 pandemic. Neuro Oncol 2020;22:1884-6.
11. Yang Y, Shen C, Hu C. Effect of COVID-19 Epidemic on Delay of Diagnosis and Treatment Path for Patients with Nasopharyngeal Carcinoma. Cancer Manag Res 2020;12:3859-64.
12. Offenbacher R, Knoll MA, Loeb DM. Delayed presentations of pediatric solid tumors at a tertiary care hospital in the Bronx due to COVID-19. Pediatr Blood Cancer 2021;68:e28615.
13. Dvori M, Elitzur S, Barg A, Barzilai-Birenboim S, Gilad G, Amar S, et al. Delayed diagnosis and treatment of children with cancer during the COVID-19 pandemic. Int J Clin Oncol 2021;26:1569-74.
14. Kebudi R, Chantada G, Kurucu N, Tuğcu D, Mukkada S, C Moreira D. COVID-19: Consequences for Children With Cancer in Turkey and Globally. Turk Arch Pediatr 2021;56:295-9.
15. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health 2020;4:e10-e11.
16. Saab R, Obeid A, Gachi F, Boudiaf H, Sargsyan L, Al-Saad K, et al. Impact of the coronavirus disease 2019 (COVID-19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia region: A report from the Pediatric Oncology East and Mediterranean (POEM) group. Cancer 2020;126:4235-45.
17. Ismail Beypinar Mu. Intravenous Chemotherapy Adherence of Cancer Patients in Time of Covid-19 Crisis. Uluslararasi Hematoloji-Onkoloji Dergisi 2020;30:133-8.
18. Kebudi R, Kurucu N, Tuğcu D, Hacısalihoğlu Ş, Fışgın T , Ocak S, et al. COVID-19 infection in children with cancer and stem cell transplant recipients in Turkey: A nationwide study. Pediatr Blood Cancer 2021;68:e28915.
19. Balduzzi A, Brivio E, Rovelli A, Rizzari C, Gasperini S, Melzi ML, et al. Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati. Bone Marrow Transplant 2020;55:1900-5.