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.