Organizational Challenges in the Pediatric Onco-hematology Units During the First and Second Wave of the COVID-19 Pandemic: A National Survey in Italy.

This study aimed to describe and compare, at a national level, the measures implemented in the pediatric onco-hematology units and the number of infections among patients and healthcare staff during the first and second wave of the COVID-19 pandemic in Italy. A multicenter, descriptive, online survey was conducted between15th March and 15th April 2020 (T1) and between 1 and 31st January 2021 (T2). All the Italian Pediatric Oncology and Hematology Association (AIEOP) centers were invited to participate in the study. Data of the pre-pandemic, first, and second phase were compared. Thirty-six of the 48 AIEOP centers completed the survey (75%). Several organizational, screening, and swab measures were implemented by AIEOP centers to prevent the SARS-CoV-2 infection among patients and visitors. During the pandemic, there was a significant reduction in the number of onco-hematology inpatient beds (p < 0.001), including inpatient beds dedicated to hematopoietic stem cell transplantation (HSCT), and consultations in the outpatient clinics (p < 0.001). During the first wave, 37 pediatric patients with cancer tested positive for SARS-CoV-2 versus 174 patients during the second wave. The reduction in routine services was also greater in the second than in the first wave. All the AIEOP centers showed the capacity to adapt and promptly respond to both waves of the pandemic.

Pediatric onco-hematological home care during COVID-19 pandemic.

The aim of the work is to describe the protocol adopted by the Home Care Service in pediatric onco-hematological patients of a large cancer institute in Italy during COVID-19 pandemic and to present preliminary data. Based on our experience, we have developed strategies to ensure continuity of care, non-abandonment, and protection of patients and operators in a period of emergency like this. In this context, the "COVID at home" protocol plays a central role. It aims to be able to safely manage COVID-19 positive onco-hematological patients, allowing nursing and medical care in the home setting, identifying patients at risk for COVID-19 infection, and rationalizing improper accesses to the hospital.

[Management of the Covid-19 epidemic in Italian Pediatric Hematology and Oncology centers: a nurse-led AIEOP national survey]. / Gestione dell'epidemia Covid19 nei centri di oncoematologia pediatrica Italiani: survey nazionale AIEOP condotta da infermieri.

INTRODUCTION: The COVID-19 pandemic is causing a global health emergency. Health systems are under extreme pressure because of the outbreak. Pediatric population seems to be less prone to develop a severe course of the disease. Still the information about COVID-19 infection and children affected by cancer are few. AIM: This survey aims to highlight preventive and control measures to manage COVID-19 infection in Italian Pediatric Oncology and Hematology Association (AIEOP) centers. METHODS: A multicenter, descriptive survey design was used. All the AIEOP centers were invited to complete an on-line survey. Data collection was performed between March 15, 2020 and April 15, 2020. RESULTS: Thirty six out of 48 centers responded to the survey. All the centers implemented similar preventive measures in order to control the COVID-19 spread and 77.8% of centers have created structured pathways, specific protocols or procedures; 30% of centers reduced the number of inpatient beds and 90% outpatient activity. The prevalence data collected report 14 children positive and 35 healthcare professionals positive. DISCUSSION: COVID-19 is not spreading homogeneously in Italy and children are less infected. It will be necessary to define new processes and new strategies to ensure safety and continuity of care to children affected by cancer, even in the future, when the lockdown will end, and new measures will be implemented.

The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review.

Despite the fact that cancer patients seem to be at a higher risk of being infected with SARS-CoV-2, limited data are available in the pediatric oncology setting. A systematic rapid review was conducted to analyze scientific literature regarding the management, interventions, and strategies adopted to prevent the spread of COVID-19 in the pediatric cancer population. Our search on PubMed, Scopus, Cochrane, and EMBASE databases yielded 505 articles. After removing duplicates, 21 articles were included. Articles focused on infection prevention (n = 19; 90.5%), management (n = 18; 85.7%), overall management of specific treatments for cancer (n = 13; 61.9%), and education (n = 7; 33.3%). The interventions adopted to prevent the spread of COVID-19 were similar across organizations and in line with general recommendations. Most of them reported interventions that could be used as valid strategies for similar emergencies. The strategies included limiting the risk of contagion by restricting access to the wards and implementing hygiene measures, the identification of separate pathways for the management of patients suspected or confirmed to be infected with COVID-19, the postponement of people accessing the hospital for non-urgent or unnecessary tests or medical examinations, and the preventive screening of patients before chemotherapy treatment or transplantation of hematopoietic stem cells. It is necessary to identify key indicators in order to better evaluate the effectiveness of the interventions implemented over time. A summary of the recommendations is provided.