COVID-19: Current impact on pediatric oncology care and
research
As of May 6, 2020, the COVID-19 pandemic, caused by the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2), has reached over 3.5
million cases and over 245,000 deaths globally.5 The
pandemic has caused healthcare capacities to be exceeded in many
countries, most notably in China, Italy, Spain, the United Kingdom and
the United States. As a result, healthcare workers and associated
hospital staff have been challenged with depleting basic care
necessities for themselves and their patients. In addition, routine
patient care, including preventative care like vaccination
administration and well-childcare, has been disrupted.
Beyond the devastating toll on human life and the healthcare systems,
COVID-19 has caused severe economic disruption, negatively impacting the
way of life for millions through necessary social isolation and
work-from-home policies as well as indefinite job furloughs or even
permanent job loss. Millions of people have been confronted with
difficulties in providing for themselves, their families, or their
employees. Healthcare systems have not been immune to negative budget
effects, especially pediatric hospitals that have seen a shift to focus
on COVID-19 and lower patient volumes for routine and elective care
resulting in revenue loss and need for mandated worker furloughs.
Yet most pediatric hematology/oncology and transplant care continues,
albeit with some modifications, including deferrals of off-therapy
visits and imaging, long-term/survivorship follow-up visits,
non-essential transplants as well as the use of telemedicine to replace
non-urgent follow-up appointments. In contrast, patients with new
hematologic or malignant diagnoses and those on-therapy patients appear
to be receiving necessary therapies, including hematopoietic cell
transplants. This experience differs from adult cancer care, which has
been modified substantially given the burden of severe COVID-19 in adult
patients.6
In contrast to maintaining continuity in clinical pediatric cancer care,
pediatric cancer research has been significantly interrupted by the
COVID-19 pandemic. Interruptions in research include disruptions in both
clinical and basic science research, performance of only essential
laboratory research, limited or deferred opening of new intervention and
non-intervention clinical trials, delayed or deferred data collection
and reporting, and reduced revenue to support research (Table
1 ).
Support from patient advocacy groups and charitable organizations are
critical to pediatric cancer research, given the comparatively low
levels of government funding earmarked for pediatric cancer research.
Examples of support from advocacy groups include financial support for
new research via grant funding, resources for patients and families to
engage in clinical trials such as providing financial support for
housing and transportation, patient and family education, and government
advocacy at the local and national levels. Challenges during COVID-19
for patient advocacy groups and the charity sector include: limited
resources for patients and families mainly due to dramatically reduced
philanthropic support, but also due to social restrictions affecting
patient movement and lodging; reduced community engagement given direct
effects of the pandemic on donor finances and health; and less
government advocacy impact given its focus on the pandemic and its
reallocating resources to address the pandemic (Table 2 ).
Importantly, industry has a vital role in supporting pediatric cancer
research through drug discovery, laboratory research, and co-development
of and support for clinical trials. Current challenges faced by industry
include reduced available workforce, reallocation of resources to focus
on assessment of pipelines for agents with potential value for COVID-19
patients, and contracted budgets for drug discovery (Table 3 ).
Taken together, COVID-19-related challenges among academic institutions,
advocacy groups and pharmaceutical industries are significant. How
profound the impact these challenges will have on pediatric oncology
research will be determined by several factors: sustained prevalence of
COVID-19 determined by availability of point-of-care viral screening and
serologic testing as well as vaccine development; favorable
risk-benefits for loosening social restrictions that currently limit
research as well as impact patients and families; availability of
laboratory reagents and clinical therapies as determined by supply line
disruptions; and availability of funding and resources at the
institutional, government7 and
philanthropic8 levels based upon recovery of global
and local economies.