DISCUSSION
COVID-19 pandemic has changed life as we knew. This pandemic has brought overwhelmed health care systems, leading to resource optimization, postponing non-urgent processes, relocating staff or promoting telemedicine.
Pediatric oncology patients, including neuro-oncology patients, have been in an extremely vulnerable situation during this period. It is well known that delays in diagnosis can result in more advanced disease stage, and delays or interruption in treatment can result in treatment failure or tumor relapsed (3). This is in addition to a highly risk of acquiring infection in hospitals and developing complications due to immunosuppression.
Although there have been publications about impact of COVID-19 in pediatric oncology patients, there is few available data about children with brain tumors. Most of them measure its impact by surveying centres about administration during COVID-19 pandemic or describe small case series of delays in diagnostics. This is why we share our experience in order to help other Pediatric Neuro-Oncology units, especially in countries with limited resources.
These vulnerability and impact of COVID-19 in children with cancer has concerned oncology units, which have adopted several preventive measures to keep patients assistance safely (2)(4)(5). One of them has been telemedicine, in order to keep in touch with patients who could not attend the hospital. In our experience, many parents preferred to in-person visits, even when a telephone consultation was offered instead. Despite having more on-site visits than strictly necessary, following all the preventive measures, this did not result in an increase in COVID-19 infection among our clinic cohort.
The incidence of COVID-19 during first wave of pandemic in our unit has been low (0,8%), comparing to literature(4). Only one patient had SARS-CoV-2 confirmed infection. This patient was tested while in intensive care unit, and did not have any symptoms of COVID-19 or known positive contact. There was only one confirmed contact (0,8%), who did not developed infection. In our perception, most of parents were conscious and aware of risk of COVID-19.
Delayed referral of pediatric brain tumors has been well documented during first wave(6). In our cohort only one patient was diagnosed later due to a several months gap between symptom onset and medical consultation due to home lockdown measures.
The unprecedent situation of shortage of beds, lack of ventilators, medication, blood products and staff, delays in treatments such as chemotherapy and radiotherapy, and delays in imaging and surgery, has been described all around the world (3)(7)(8)(9). Although International Societies recommend that planned diagnosis and treatment of children with cancer should continue with as few modifications as necessary (2).
In our unit, it was more frequent to postpone imaging than radiotherapy or chemotherapy. Surgery has not been analysed, as well as shortage of medication or blood products.
Comparing to other countries like the POEM group survey including 34 centres, there were delay in chemotherapy in 10 centers (29%) and in radiotherapy in 16 centers (47%)(3). Comparing to patients in Latin America, in a survey of 553 patients corresponding to 20 centers, there were a delay or modification in chemotherapy in 36% cases and in 33% of radiotherapy treatments (9). There is less data about imaging test, which is important, especially MRI, in patients with brain tumors, both in diagnostic and follow-up.
These comparisons are difficult due to the differences between countries and socio-economic situations. Our unit is also located in a pediatric hospital which has not attended adults, without shortage of critical care beds.