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.