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CANCER is a major cause of death in children worldwide and the global coronavirus disease 2019 (COVID-19) pandemic is affecting delivery of optimal care to this vulnerable patient population.
The emerging literature about the impact of COVID-19 on children suggests greater incidence of mild or asymptomatic illness in children compared with adults. There is, however, concern from paediatric oncologists globally that there is scarce evidence about the true impact of COVID-19 in immunocompromised children with cancer (here and here). Moreover, there is early evidence from adult oncologists in China that there is an increased risk of COVID-19 in adults with cancer. This, in conjunction with emerging evidence about long term sequelae of COVID-19 in children such as development of a Kawasaki-like disease, gives reason for pause and requires ongoing evaluation as the pandemic reaches new heights worldwide.
Childhood cancer does not stop when a global pandemic occurs. It is vital to consider the impact of the COVID-19 pandemic beyond the medical sequelae of the virus on children with cancer. As Australia now begins to emerge from the feared second wave of the pandemic, there are undoubtedly far-reaching impacts on children with cancer. These impacts include the mental health toll for families receiving childhood cancer treatment as well as the impact of care delivery within cancer centres and concern about the “distraction effect” caused by focus on a global pandemic.
Receiving a diagnosis of childhood cancer is a time of significant psychosocial stress and anxiety for many children and families. Furthermore, the treatment of many childhood cancers includes many months to years of immunosuppressive therapy where the risk of infection-related morbidity and mortality looms over families in addition to the constant fear of relapse. Add to this milieu the threat of contracting COVID-19 in the midst of a global pandemic, and the anxiety perceived by patients and families is completely understandable but poorly acknowledged by the social supports, the community and the wider society. Moreover, self-isolation measures have resulted in limited support systems for families, as the extended family and social supports dwindle due to COVID-19 restrictions and separation by domestic and international border closures.
In addition to the high levels of emotional distress and social isolation, the majority of families who receive a diagnosis of childhood cancer report some degree of economic hardship. While many factors contribute to this hardship, it is largely driven by the need for a full-time caregiver to forgo employment for many months or years to care for their child. The significant increase in unemployment in Australia as a result of the COVID-19 pandemic has already escalated this hardship for many families receiving treatment for childhood cancer. In addition, the charitable organisations that many families rely on to assist them financially through their child’s cancer treatment have been victim to the financial strains that are associated with the economic downturn and cancellation of many fundraising events.
Optimal care for children with cancer is often delivered by a heavily resourced multidisciplinary team, who typically work in the paradigm of a tertiary hospital setting. Currently, measures are being implemented across the country to minimise transmission of COVID-19 in health care settings and these measures have impacts on delivery of cancer care. Many institutions have restricted the numbers of caregivers who attend hospital visits to one per child. Given children with cancer can spend weeks to months in hospital, these restrictions have significant impacts on guardians who are now at higher risk of carers fatigue. Children with cancer who are febrile or have respiratory symptoms now have nasal and deep throat swabs for COVID-19. These swabs can be both uncomfortable and traumatic for children who may need multiple swabs for recurrent symptoms and experience numerous other traumatic procedures as part of their cancer care.
Health care professionals who care for children with cancer are currently working tirelessly to ensure the COVID-19 pandemic does not cause us to lose sight of the main goals at hand: to cure childhood cancer and have healthy survivors. As we pivot to telehealth consultations to minimise risk of COVID-19 transmission, we extend ourselves to ensure we are not compromising cancer care by doing so. As we go about our lives outside of work, we ruminate upon the decisions we make in our personal lives and fear that we will be the conduit of transmission to our immunocompromised patients or to our vulnerable loved ones.
The future of childhood cancer care in the midst of a global pandemic is an uncertain one, but one in which the global paediatric oncology community must continue to collaborate to move forward.
Dr Neevika Manoharan, Kids Cancer Centre, Sydney.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.