Grappling with Pediatric Cancer During COVID-19 Pandemic: How do patients receive care?

Article written by Rowz Fajardo

Edited by Patrick Caro

Fighting against a chronic disease at an age where you have barely explored much about the world and life is a tough battle. But with the current global situation, struggling with such a disease is much worse. Children with cancer grapple with their disease while making sure they do not acquire the recent coronavirus disease (COVID-19) because they are one of the most vulnerable to it. The COVID-19 pandemic has deeply affected the world. Countries are struggling with shortages of basic medical care items such as intensive care unit beds, ventilators, personal protective equipment, disinfectants, and even essential household and dietary necessities. Hospitals are mostly affected, striving to maintain safety for their patients and staff, care for the sick, and comfort bereaved families. The COVID-19 has already taken several lives and as it still has no cure, it continuously spreads risks to the people. In the search of the cure for COVID-19, global medical attention is diverted or focused on treating COVID-19 patients and preventing others from infection. Hospital transactions and medical treatments of non-COVID-19 patients, especially those struggling with chronic diseases like cancer, are affected by the restrictions set by country leaders to contain the spread of COVID-19. Several arrangements are altered. One of these is the medical care provision for children with cancer. Response to the COVID-19 pandemic has led to significant modifications in access to care for pediatric cancer. With these changes, how do little warriors of pediatric cancer receive care? What are the changes and interventions in their usual medical transactions? How are the kids given treatments that require machines and the supervision of health experts? How do hospitals ensure their safety against the acquisition of the COVID-19 virus?

According to Pediatric Oncology East and Mediterranean Group — a collaboration of institutions in the Middle East, North Africa, and West Asia working on pediatric cancer treatment, pediatric cancer is a highly curable disease provided that timely, accurate diagnosis and appropriate therapy are followed. With the current crisis, delivering care for patients with cancer is challenging given the competing risks of death from cancer versus death or serious complications of the COVID-19. The current crisis led to changes and interventions in the usual medical transactions of pediatric cancer patients. To follow protocols set by country leaders and deliver safe and effective care to the sickest patients, hospitals have been postponing non-urgent procedures and therapies and are widely replacing face-to-face patient encounters and transactions with telemedicine. Since quarantines started, cancellations in off treatment visits, delays in essential treatments and therapies, restrictions of acceptance of new patients, shortages in blood products and medications, and interruptions in surgery and radiation treatments have been reported. Some off-therapy surveillance visits of pediatric cancer patients are delayed as has been recommended internationally as a measure for avoiding congestion on clinics and to practice social distancing in clinic areas. Delays in chemotherapy administration visits, tumor local-control measures by surgery or radiation are reported. These are alarming as it can lead to increased tumor relapses and treatment failures which can worsen cancer conditions. Reports regarding the restriction of accepting new pediatric oncology patients surfaced. These can potentially cause an increase in the load of other medical centers and raise concerns about patients who are not given access to curative therapies. There are also ongoing shortages in blood supply and medications in most hospitals which can disrupt lifesaving supportive care. These changes and interventions are due to the patients’ families’ fear of exposure to COVID-19, barriers to travel because of halted public transport, economic duress due to loss of jobs and daily wages, and the interruptions in social services support. Since the global crisis started, health care service to non-COVID-19 patients is a bit compromised. Efforts to address these concerns such as expanding the use of telemedicine to provide a channel for consultations without face-to-face interactions. In some hospitals, observing prioritization of interventions in patients with non-communicable diseases, especially cancer, have helped in certain contexts.

Because physical consultations are limited, while pediatric cancer patients are at home, their caregivers or guardians are asked to watch out if the patient has a fever especially when he or she is feeling warm, flushed, chilled, or not well. The Centers for Disease Control and Prevention (CDC) recommends that if a patient has a temperature of 38ºC or higher, he or she must contact a doctor right away. Patients are also required to clean their hands as often. With the guidance of their caregivers or guardians, patients must know the signs and symptoms of infection during chemotherapy. They must immediately call a doctor if signs and symptoms have been observed as infection can lead to hospitalization or death. Patients are also being asked to avoid people and avoid leaving their homes as much as possible for cancer patients who are very vulnerable to COVID-19. Like everyone else, patients need to cover their mouth and nose with a mask to protect themselves from possible infections. As for surgeries and treatments that require machines and supervision of health experts, there is a delay in appointments depending on the patient’s location and access to hospitals. Some people may need to reschedule appointments. Patients have to contact their oncologists for the best course of action depending on their circumstances online or over the phone and as much as possible not physically going to the clinic. They can only go once there is a set appointment. Other patients are also asked to switch to other options in getting their cancer medicines. Some are recommended to switch to oral medicines instead of infusions while others can have home infusions.

Hospitals ensure safety against the acquisition of the COVID-19 virus by delaying or deferring non-essential clinic visits and making use of phone consultations or telemedicine. If face-to-face consultations are necessary and immediate, there is a “one patient, one guardian” rule that must be observed as much as possible. Patients are required to wear a mask or facial covering along with their guardians. Physical distancing is also strictly followed. There is also a limit on how many patients can only be accommodated for the day. There are also intervals in every transaction for disinfection. Patients who need longer stay in the hospital for treatment are also asked to be pre-screened for COVID-19-related symptoms before appointments.

The health sector is practicing resilience despite adversities through efforts of trying to maintain their lines open for consultations despite limitations in interactions through the adoption of telemedicine. The spirit of collaboration through local and regional teamwork is commendable. These alliances between hospitals help them, other hospitals, and medical experts navigate the changing landscape of healthcare delivery amid this pandemic. Findings from these collaborations can be used to be prepared to meet future similar challenges. The global pandemic brought oncologists together to brainstorm and have guidance on how to alter health care delivery effectively without big compromises in times of challenging global conditions.

Pediatric cancer, although stated as largely curable, is still a disease. It poses threats to the health of diagnosed children. Pediatric cancer patients suffer not having regular lives because of the disease they are bearing. They are limited things they can do and things they can have. Possible delays and interruptions can affect their treatments with intensity depending on their disease stage. Delays in diagnosis can result in a more advanced stage at presentation and an alarming prognosis. Interruptions in treatments, medications, and intensive therapies can lead to treatment failure and increased rates of tumor relapse. Global health sectors, with the support of the people and world leaders, must continue collaborative efforts to better understand the impacts of the current pandemic to the provision of care for non-COVID-19 patients like those who are diagnosed with cancer. Resource-appropriate modifications must be ensured to sustain curative outcomes for pediatric patients while considering their, their families, and the health workers’ safety from the coronavirus. Evaluation of the effects of the pandemic regarding access to timely, accurate, appropriate, and lifesaving diagnoses, therapies, and supportive care is vital to know the best steps and processes to take to continue provision of quality medical care to pediatric cancer patients who are among the most susceptible to the virus because of their disease. The children are the world’s greatest treasure. They are the world’s future regardless of health status. Pediatric patients need to be heard and considered during this time of the pandemic. The COVID-19 may have posed serious threats to several aspects of human lives, but the people are in this together. The whole world will get through this together.

Inspiring hope, one pediatric patient at a time. #ForTheKids!