Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India

Background: Patients with cancer are at a higher risk of getting infected with the severe acute respiratory syndrome coronavirus 2 owing to their immunocompromised state. Providing care to these patients amidst the first wave of the coronavirus disease-2019 (COVID-19) pandemic was extremely challenging. Objective(s): This study was aimed at evaluating the clinical profile and disease-related outcomes of pediatric patients with hematological illnesses and cancer. Material(s) and Method(s): This retrospective study was conducted at a tertiary care center in North India during the first wave of the pandemic from March 2020 to December 2020. Children aged up to 18 years, who were treated for a hematological illness or malignancy or underwent hematopoietic stem cell transplantation (HSCT) and tested positive for COVID-19 regardless of symptoms were included in the study. Baseline demographic data related to the age, diagnosis, treatment status, and chemotherapy protocol used were collected. Outcomes including the cure rates, comorbidities, and sequelae were recorded. Result(s): A total of 650 tests for COVID-19 were performed for 181 children;22 patients were found to be COVID-19 positive. The most common diagnosis was acute leukemia (63.6%). None of the patients developed COVID-19 pneumonia. The majority of patients had asymptomatic infection and were managed at home. Among those with a symptomatic infection, the most common symptoms were fever and cough. A total of 3 (13.6%) patients needed oxygen therapy, one developed multisystem inflammatory syndrome of children leading to cardiogenic shock. Three patients required intensive care or respiratory support;all the patients had favorable clinical outcomes. The median time from the onset of COVID-19 to a negative result on the reverse transcription-polymerase chain reaction test was 21.3 days. Cancer treatment was modified in 15 patients (68.2%). Conclusion(s): Our results suggest that children with hemato-oncological illnesses rarely experience severe COVID-19 disease. The impact of the first wave of COVID-19 primarily manifested as disruptions in the logistic planning and administration of essential treatment to these children rather than COVID-19 sequelae.Copyright © 2021 Cancer Research, Statistics, and Treatment Published by Wolters Kluwer - Medknow.

Reducedhumoral response against variants of concern in childhood solid cancer patients compared to adult patients and healthy children after SARS-CoV-2 vaccination.

Introduction: Although there is extended research on the response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in adult cancer patients (ACP), the immunogenicity to the variants of concern (VOCs) in childhood cancer patients (CCP) and safety profiles are now little known. Methods: A prospective, multi-center cohort study was performed by recruiting children with a solid cancer diagnosis and childhood healthy control (CHC) to receive standard two-dose SARS-CoV-2 vaccines. An independent ACP group was included to match CCP in treatment history. Humoral response to six variants was performed and adverse events were followed up 3 months after vaccination. Responses to variants were compared with ACP and CHC by means of propensity score-matched (PSM) analysis. Results: The analysis included 111 CCP (27.2%, median age of 8, quartile 5.5-15 years), 134 CHC (32.8%), and 163 ACP (40.0%), for a total 408 patients. Pathology included carcinoma, neural tumors, sarcoma, and germ cell tumors. Median chemotherapy time was 7 (quartile, 5-11) months. In PSM sample pairs, the humoral response of CCP against variants was significantly decreased, and serology titers (281.8 ± 315.5 U/ml) were reduced, as compared to ACP (p< 0.01 for the rate of neutralization rate against each variant) and CHC (p< 0.01 for the rate of neutralization against each variant) groups. Chemotherapy time and age (Pearson r ≥ 0.8 for all variants) were associated with the humoral response against VOCs of the CHC group. In the CCP group, less than grade II adverse events were observed, including 32 patients with local reactions, and 29 patients had systemic adverse events, including fever (n = 9), rash (n = 20), headache (n = 3), fatigue (n = 11), and myalgia (n = 15). All reactions were well-managed medically. Conclusions: The humoral response against VOCs after the CoronaVac vaccination in CCP was moderately impaired although the vaccine was safe. Age and chemotherapy time seem to be the primary reason for poor response and low serology levels.

Outcomes of COVID-19 in children with cancer - Report from the Indian Pediatric Oncology Group (InPOG) COVID-19 registry in India

Introduction: The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Method(s): Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Result(s): A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion(s): The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.Copyright © 2022

Some key aspects of telemedicine development to support human illness: a systematic review

The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.

The care for oncologic patients undergoing pediatric palliative care and the griefs of a health team

Introduction: The health care offered to children and adolescents with cancer has been expanded, giving space to orthothanasia and palliative care, with a comprehensive look at the subject facing the threat to the continuity of life, as well as challenging professionals to access issues related to grief. Objective(s): In order to explore this reality, this study intended to analyze how professionals experience grieving processes in the exercise of palliative care in pediatric oncology. Method(s): A qualitative research was conducted with the participation of 23 health professionals working in palliative oncology and pediatric care, who responded to a semi-structured interview script, whose analyses were performed with the support of the IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) software. Result(s): The results were organized in four classes: in class 1, the specificities of the treatment of children with cancer and other aspects related to chronic illness are portrayed;class 2 shows that health trainings do not prepare professionals to deal with death and with patients with no possibility of cure, and these professionals have (pre-) concepts about palliative care;class 3 highlights the principles of palliative care and other factors of the work in this therapy;and class 4 deals with the bonds formed by professionals and their grieving experiences. Conclusion(s): Cure must not be a requirement for the provision of care in relation to children with cancer that can benefit from the adoption of palliative care therapy and the validation of the sensitivity of professionals.Copyright © 2023, Universidad Compultense Madrid. All rights reserved.

Comparison of Telemedicine with In-Person Outpatient Palliative Care Visits for Children with Cancer (Sch420)

Outcomes: 1. Define quality metrics and health outcomes as they relate to outpatient pediatric palliative oncology care. 2. Analyze differences in palliative interventions delivered in telemedicine versus in-person visits and investigate potential reasons for these differences. Background(s): Contrary to the inpatient focus of most pediatric palliative care (PPC) teams, children with cancer receive the majority of their care in the clinic, highlighting the importance of outpatient PPC for this population. Although many models of care exist, telemedicine use in PPC became nearly universal during the COVID-19 pandemic. While early studies suggest feasibility and acceptability, little is known about the quality of PPC delivered via telemedicine to children with cancer. Objective(s): To compare telemedicine with in-person outpatient palliative care visits in pediatric oncology patients. Method(s): Descriptive retrospective chart review of outpatient PPC visits at a large freestanding children's hospital occurring via telemedicine or in clinic during 2020 and 2021 for children with a primary palliative care diagnosis of cancer. Reason for visit and palliative intervention will be evaluated for telemedicine and in-person visits. Outcomes, including intensive care unit (ICU) and emergency department visits, death in the ICU, and hospice referrals, will be compared among patients with only telemedicine visits, only in-person visits, and both visit types through 2022. Descriptive statistics will be reported. Result(s): Of 394 patients with outpatient PPC visits in 2020 or 2021, 82 were determined to have a primary oncologic diagnosis: 44% solid tumors, 35% leukemia/lymphoma, and 21% CNS tumors. In total, 254 outpatient visits (212 in person, 42 telemedicine) were completed. Five patients had only telemedicine visits, 52 had only in-person visits, and 25 had both visit types. Overall, 72% of patients are deceased to date;of those, 25% (telemedicine 0%, in person 27%, both types 28%) died in the ICU. Additional results are pending. Conclusion(s): Given the small number of patients seen solely via telemedicine, we anticipate difficulty in detecting true differences in health outcomes but are hopeful differences may be more apparent on the encounter level due to a more robust sample size.Copyright © 2023

An outpatient service evaluation in a UK tertiary referral centre for paediatric and adolescent gynaecology

Background: Pressure on waiting lists prompted this service evaluation in a tertiary referral centre for paediatric and adolescent gynaecology (PAG). The service is located in Bristol in England. The centre is one of 11 commissioned by NHS England to provide care for patients with congenital gynaecological anomalies, as well as seeing patients with other PAG presentations from aged 2 upwards. Alongside general PAG clinics, there is a quarterly multi-disciplinary transition clinic for children with differences in sex development and a monthly joint adult endocrinology / gynaecology clinic where patients with Turner Syndrome are seen annually. Aim(s): To collect and analyse data pertaining to the pre-Covid PAG outpatient service, to inform1 anticipated service developments aimed at reducing waiting list times for new patients and streamlining of services for certain patient groups Methods: This service evaluation was registered with the local clinical audit team (GYNAE/SE/2020-21-11). We performed a retrospective review of the electronic notes of every PAG appointment from 1st March 2019 - 29th February 2020 (pre-Covid-19 UK restrictions). A database of PAG clinics was created and then the team manually went through each appointment's notes / letters and extracted the relevant data which was entered into a Microsoft Excel spreadsheet. Result(s): There were 385 appointments during this time period. There was data available for 376 appointments and 338 of these were filled by PAG patients. 72 appointments were (21%) for primary ovarian insufficiency (POI) of late effects of childhood cancer, 53 (16%) were for patients with Turner syndrome and 48 (14%) for heavy menstrual bleeding, of which 23 (48%) were new referrals, with this being the most common reason for referral to the team. The remaining appointments were for a variety of conditions. Conclusions and Actions: Our services would benefit from streamlining to maximise capacity and reduce waiting times. To this end: - A second endocrinologist has been recruited to double capacity for the Turner Syndrome clinic2. - An adolescent heavy menstrual bleeding clinic3,4 has been set up to streamline care for these patients. This is a one-stop face-to-face clinic offering a transabdominal pelvic ultrasound scan and a telephone follow-up 3 or 6 months later - To consider a POI / late effects of childhood cancer service to run alongside the menopause and reproductive medicine clinics with psychology support5 PAG constitutes a wide range of diagnoses, and a regular assessment is helpful to ensure care can be offered as efficiently as possible.Copyright © 2023

RECOMMENDATIONS OF NATIONAL CONSULTANTS ON VACCINATION AGAINST SARS-COV-2 IN CHILDREN WITH MALIGNANCIES OR AFTER HEMATOPOIETIC CELL TRANSPLANTATION.

With accumulating data on severe course of SARS-CoV-2/COVID-19 infection in children, it should be taken into account that immunocompromised patients are at increased risk of complications and death due to this disease. Currently vaccination is the only option to prevent the disease. Nowadays more and more data are coming on vaccination in children and in patients with immune deficiencies. In this paper, Polish National Consultants in pediatric oncology and hematology and clinical immunology present recommendations on vaccination in children with malignancies or after hematopoietic cell transplantation. These recommendations are based on ECIL-9 guidelines, adopted to national situation and updated with the latest information. With the fast changing knowledge and statements provided by Center for Disease Control (CDC), Food and Drug Administration (FDA) and European Med-icines Agency (EMA), such recommendations need to be regularly updated. Nevertheless, individual risk/benefit ratio should be always assessed for each patient, particularly in the case of the risk of poor immunological response to immunization.Copyright © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Prognostic impact of CT severity score in childhood cancer with SARS-CoV-2

BackgroundCT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease.The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care.A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. CT findings were evaluated for lung involvement and CTSS was calculated and range from 0 (clear lung) to 20 (all lung lobes were affected).ResultsOverall, 89% of patients had hematological malignancies and 92% were under active oncology treatment. The main CT findings were ground-glass opacity (70%) and consolidation patches (62.5%). In total, 85% of patients had bilateral lung involvement, ROC curve showed that the area under the curve of CTSS for diagnosing severe type was 0.842 (95% CI 0.737–0.948). The CTSS cut-off of 6.5 had 90.9% sensitivity and 69% specificity, with 41.7% positive predictive value (PPV) and 96.9% negative predictive value (NPV). According to the Kaplan–Meier analysis, mortality risk was higher in patients with CT score > 7 than in those with CTSS < 7.ConclusionPediatric oncology patients, especially those with hematological malignancies, are more vulnerable to COVID-19 infection. Chest CT severity score > 6.5 (about 35% lung involvement) can be used as a predictor of the need for hospitalization.

SARS COV-2 Infection in Children with Leukemia

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directed great attention and anxiety all over the world. Epidemiologic models predict that the current COVID-19 pandemic will last several months or even several years, until the development of a vaccine and/or herd immunity. Although the course of the infection is often not severe in children, it can be life threatening especially in immunocompromised children with leukemia. Hematopoietic and lymphoid cancers are accounting for approximately 40% of all childhood cancers. The five-year survival rate for childhood cancer has approached to 70% and more than 80% for leukemia in our country. During COVID pandemic, children with leukemia may also have COVID-19 infection, especially when their bone marrow is depressed due to chemotherapy. It is observed that factors such as the underlying type of cancer, status of remission, or having stem cell transplantation may affect the prognosis. As well as standard and proven treatments for febrile neutropenia, all tests and treatments should be applied very quickly and properly for COVID 19 as is all suspected patients. These efforts may contribute to increase the survival of our children with cancer. Given the absence of data to address concerns related to SARS-CoV-2 infection while on chemotherapy, questions are increasing about the approach for management of systemic immunosuppressive therapies, i.e. ceasing or reducing the immunosuppressive medications in children with leukemia. The current rapid worldwide spread of COVID-19 necessitates identifying optimal preventive strategies and effective medical management. In this report, we tried to review appropriate literature-based approaches for prevention, diagnosis and management of treatment protocols for children with cancer during the pandemic period.

Challenges to Sustainability of Pediatric Early Warning System (Pews) in Resource-Limited Hospitals in Latin America

BACKGROUND AND AIM: Pediatric Early Warning Systems (PEWS) are evidence-based interventions that improve early identification of deterioration in resource-limited hospitals. While PEWS can be successfully implemented in these settings, little is known about their sustainability postimplementation. This study evaluates staff perspectives on the importance of, and challenges to, sustaining PEWS. METHOD(S): We conducted semi-structured interviews of PEWS implementation leaders and hospital directors at 5 pediatric oncology centers sustaining PEWS in Latin America. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed combining a priori and inductively derived codes. Transcripts were independently coded by 2 coders achieving a kappa of 0.8-0.9. Thematic content analyses explored staff perceptions on PEWS sustainability. RESULT(S): We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefit. However, participants reported a range of challenges sustaining PEWS, including fluctuations in human and material resources needed for PEWS, staff turnover and insufficient training, difficulty achieving new leadership buy-in, lack of internal systems to promote ongoing monitoring of PEWS, and the COVID-19 pandemic (Table 1). Together, these challenges resulted in multiple impacts, ranging from a small reduction in PEWS quality to complete disruption of PEWS use resulting in loss of benefits to patient outcomes in some units. CONCLUSION(S): While sustainability of evidence-based interventions like PEWS is valued by staff in resourcelimited hospitals, participants reported multiple challenges to sustainability resulting in reduced patient benefit. Future work should focus on identifying factors that promote intervention sustainability in these settings. (Table Presented).

Severe Sars-Cov 2 Lung Infection in a 2-Year-Old Girl Undergoing Chemotherapy for Acute Lymphoblastic Leukemia: A Case Report

BACKGROUND AND AIM: Sars-CoV-2 infection can lead to severe pulmonary impairment at all ages, however, the best therapy in children is not established. Our objective is to discuss a severe pulmonary case in a pediatric oncology patient who presented good clinical evolution and the therapeutic measures chosen in its management. METHOD(S): Case report and literature review. RESULT(S): A 2-year-old girl undergoing chemotherapy for acute lymphocytic leukemia had received cytarabine and methotrexate one week before being admitted to the ward for febrile neutropenia, identified with Sars-Cov-2 infection by RT-PCR. Referred to pediatric intensive care on day 3 of symptoms when she was prostrate and antibiotics switched to a broader spectrum. On day 8 of symptoms she rapidly developed respiratory failure and required mechanical ventilation at high parameters, CT scan showed lesions in ground glass in 75% of the lung parenchyma. On day 9, she was still feverish and showed altered inflammatory tests, such as ferritin 4492 mcg/L D-dimer 5909 ng/dL CRP 28 mg/ dL. Cardiac, hepatic and renal functions remained stable. At that moment, the patient received gammaglobulin 2g/kg in a single dose and methylprednisolone 2mg/kg/day for 5 days. Substantial improvement was observed 48 hours after the introduction of anti-inflammatory therapy, allowing for weaning and extubation after 7 days of mechanical ventilation. 72 hours after extubation, she was discharged home, breathing normally on room air. CONCLUSION(S): Severe Sars-Cov-2 lung infection in a pediatric oncology patient with markedly high inflammatory tests was treated with anti-inflammatory therapies such as steroids and gammaglobulin, with rapid and favorable recovery (Figure Presented).

Plasma Cell Free Deoxyribonucleic Acid (cfDNA) Fungal Polymerase Chain Reaction (PCR): a Non-Invasive Diagnostic for Invasive Fungal Disease Evaluation in At-Risk Pediatric Oncology and Stem Cell Transplant Patients

Background. Molecular diagnostics appear promising for early, non-invasive detection of invasive fungal disease (IFD) in immunocompromised patients. Our clinical lab developed and validated cell free DNA (cfDNA) fungal polymerase chain reaction (PCR) assays (Table 1), which have been in clinical use since November 2020 and were recently included in an institutional pediatric clinical care pathway for prolonged febrile neutropenia. We aimed to evaluate the performance of these plasma cfDNA fungal PCR assays in pediatric oncology and hematopoietic stem cell transplant (HSCT) patients with clinical concern for IFD. Methods. We initiated an observational study of inpatient oncology and HSCT patients who had plasma mold panel (+/- Candida panel) cfDNA fungal PCR obtained as part of an IFD evaluation at our freestanding quaternary care children's hospital. The primary outcome was IFD clinical diagnosis (proven, probable, possible, unlikely) as per EORTC/MSG+ definitions within one month of the cfDNA fungal PCR, which was assigned independently by two physicians, with a third physician utilized in cases of discrepancy. Patient demographics, hospital course, imaging results, and clinical laboratory data were ed and maintained in an encrypted REDCap © database. Results. In a preliminary analysis of October 2021-March 2022 data, there were 21 IFD evaluations for 18 patients (Table 2). Most oncology evaluations were for prolonged febrile neutropenia, while many HSCT were non-neutropenic, but on enhanced immunosuppression with new clinical concerns (e.g., respiratory symptoms, persistent fever). Plasma cfDNA detected a mold or yeast consistent with the clinical presentation in 100% of the five proven/probable cases (Figures 1 & 2). All 14 possible IFD cases had a negative cfDNA fungal PCR. Proven cases are designated with blue icon, while the probable case is orange. All five cases were in oncology patients who did not have history of hematopoietic stem cell transplant. Cell free DNA (cfDNA) fungal polymerase chain reaction (PCR) results include the organism identified, followed by the cycle threshold (Ct) in parenthesis. Maximum Ct for the assay is 45. Abbreviations: AG: Aspergillus galactomannan index (Ref <0.5);ALL: acute lymphoblastic leukemia. BAL: bronchoalveolar lavage;1,3-BDG: 1,3-beta-D-glucan (Ref <60 pg/ml);cfDNA: cell freedeoxyribonucleic acid;CNS: central nervous system;EORTC/MSG: European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group & the National Institute of Allergy&Infectious Diseases Mycoses Study Group;L-AmB: liposomal amphotericin B;SARS-CoV-2: severe acute respiratory syndrome associated with coronavirus 2. Conclusion. Upfront plasma cfDNA fungal PCR successfully detected a relevant mold or yeast with short turnaround time in 100% of cases that were later classified as proven/probable. This appears promising for early, noninvasive diagnosis that enables prompt optimization of antifungal and surgical management, particularly for mucormycosis cases. Additional data may permit consideration of Mucorales agents PCR as a new EORTC/MSG mycologic criteria. (Table Presented).

Supportive care in paediatric oncology during the pandemic : Lessons from a nationwide survey

Background: We conducted a survey among practicing pediatric oncologists in India to assess the modifications made in supportive-care during the pandemic, specifically if any of those were safe and effective enough to be practice-changing. Method(s): A survey-questionnaire with 27 questions was circulated through the emailing list and WhatsApp/Telegram groups of Indian pediatric oncology group in January 2022. Responses were accepted till 31st March 2022. The questions focused on disruptions in continuation of patient-care over past two years, strategies to minimize the impact of such disruptions, and the potential, if any, for incorporating these modifications into standard practice. Result(s): Of seventy-one responses from approximately 250 active members contacted, 39(55%) were from public hospitals and 23(32%) from centers seeing >200 new cases/year. Decline in new patient registration, funding shortage, increase in treatment abandonment and delay in maintenance/follow-up visits were reported by 7(9.8%), 37(52%),44 (62%), and 52(73%). In 25(35.2%) centers, scarcity of ICU beds during COVID waves resulted in higher non-COVID mortality/morbidity. Several centers reduced transfusion cut-offs (23,33%), used granulocyte stimulating factors more often (21, 30%), increased use of oral antibiotics in low-risk febrile neutropenia(FN) (29,40%), and stopped intravenous antibiotics earlier (11,15%). Strategies to curtail abandonment and drug default included tracking phone calls (50,72%), couriering medicines to patients homes (27,39%) and teleconsultation (43,62%). PostGAMMACotreatment follow-up frequency and investigations were reduced in 50(70%) centers and 54(76%) started teleconsultations;respondents considered these strategies likely to be incorporated into routine practice. While 35(49%) respondents supported increased use of outpatient chemotherapy, most(70,99%) respondents chose to revert to pre-pandemic policies for transfusion and FN. Establishment of sustainable shared-care networks was considered a priority by 44(62%). Conclusion(s): Pediatric oncology services were remarkably compromised during the pandemic. Of the many adaptations made to tackle the pandemic conditions, virtual follow-up of selected patients and rationalizing post-treatment follow-up and investigations are likely to continue into the post-pandemic period. Copyright © 2022

Impact of the covid-19 pandemic onpatients with paediatric cancer in lowincome, middle-income, and high-income countries: A multicentre, international, observational cohort study

Aim: 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. Method(s): A multicentre, international, collaborative cohort study. Patients recruited from 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. Result(s):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). Conclusion(s): 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.

Minimal clinical impact of the COVID-19 pandemic on paediatric oncology patients at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa

Objective. The effects of SARS-CoV2 infection on paediatric oncology patients were not fully understood. The objective of this study was to investigate the effects of COVID-19 infections on these patients at CMJAH. Methods. Patients under 18 years and their caregivers were tested. Nasopharyngeal COVID-19 PCR tests were performed on all patients with symptoms suggestive of COVID-19 infection, and those admitted for procedures, chemotherapy and treatment of any intercurrent illness. Results of all COVID-19 swab tests with corresponding full blood count results were prospectively collected. Simple descriptive statistics were used to describe the study population. Results. From 1 May 2020 to 30 September 2021, 646 COVID-19 tests were performed on 432 patients. Thirteen tests (3% of patients) were positive. Six (0.9%) of the lodger caregivers also had positive swabs, suggesting positive contacts. Five of the positive patients were admitted for chemotherapy, and three were admitted for febrile neutropenia. No other patients were neutropenic. One neutropenic patient had COVID pneumonia, requiring facemask oxygen therapy and was managed safely in the in-patient ward. The most common symptoms included fever and mucositis (23%) followed by fever and cough (15%), while 54% were asymptomatic for COVID disease. All positive patients recovered fully and did not have any features of 'long COVID'. Conclusion. The low numbers of positive oncology patients for COVID-19 may be explained by effective isolation techniques owing to pre-existing immunosuppression and effective health education. The clinical impact of the COVID-19 pandemic on paediatric oncology patients at CMJAH has been minimal.

The national recommendation for the covid-19 prevention and control in pediatric units of hematology and oncology, hematopoietic cell transplantation units and respective outpatient clinics: Guidelines of polish society of pediatric oncology and hematology

In December 2019 novel coronavirus SARS-CoV-2 has been identified. It is responsible for a pandemic COVID-19 disease with a risk of fatal outcome ranging 2% to 6%. Pediatric patients with cancer during intensive oncological treatment are considered as a risk group of unfavorable outcomes because of profound immunosuppression. Based on literature and the national local experiences, the Polish Society of Pediatric Oncology and Hematology provided with the national recommendation for the COVID-19 prevention and control in pediatric hematology and oncology, hematopoietic cell transplantation units and well as respective outpatient clinics. Copyright © 2020, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Risk of Subsequent Central Nervous System Neoplasms in Childhood Cancer Survivors after Radiation Therapy: Results from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) Collaboration

A PENTEC analysis of published investigations of central nervous system (CNS) subsequent neoplasms (CNS-SN) in childhood cancer survivors who received radiation therapy (RT) to the brain was performed to estimate the effect of RT dose and gender on the risk of CNS-SN following RT. Through the PENTEC initiative, a systematic literature review was performed to identify published data on CNS-SN after prior cranial RT in childhood cancer survivors. Using the Covidence platform 2,156 studies were screened for potential inclusion. The incidences of CNS-SNs, RT dose, age, gender, primary cancer diagnosis, and latent time from primary diagnosis to CNS-SN were extracted, to assess the factors influencing risk for subsequent meningiomas or subsequent malignant CNS tumors (e.g., gliomas). The odds ratio for CNS-SNs in different dose intervals were calculated and excess odds ratio (EOR) per Gy of developing subsequent meningiomas or malignant tumors was estimated using inverse-variance weighted linear regression to model the risk for CNS-SN versus dose. Forty studies of independent patient cohorts provided information on 736 subsequent malignant tumors with average median latency 10.3 years, and 32 studies provided information on 1,035 subsequent meningiomas with average median latency 20.5 years. Dose-response was derived from 6 studies of 248 subsequent malignant tumors and 7 studies of 557 subsequent meningiomas. The pooled EOR/Gy was 0.45 (95% CI: 0.25, 0.66) for meningiomas and 0.16 (95% CI: 0.11, 0.20) for malignant CNS tumors. The average cumulative incidence of developing a meningioma or malignant CNS tumor at 15 years of follow-up was 2.4% (range, 1.2-6.3%) or 0.9% (range, 0.4-1.8%), respectively. Females had a higher risk of meningioma than males (OR=1.5, 95% CI: 1.2, 1.8;6 studies;50,346 patients) whereas no gender difference was seen in risk of malignant tumors (OR=0.9, 95% CI: 0.7, 1.2;4 studies;32,446 patients). This PENTEC systematic review shows a significant radiation dose-response relationship and higher risk among females for meningioma, akin to the general population, and a highly significant but somewhat less steep relationship for subsequent malignant tumors with no effect of gender. Further evaluation of the effect of age and chemotherapy in relation to dose and gender is necessary to elucidate the risk of CNS-SN after RT. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)