"Continued collaboration among the international pediatric oncology community is required to get through such uncertain times.”— Rishi S. Kotecha, MB, ChB
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In a correspondence published in The Lancet Oncology, Rishi S. Kotecha, MB, ChB, of the Government of Western Australia Department of Health, identified challenges in protecting children with cancer from COVID-19 infection and stressed that some measures proposed to protect adults with cancer may not be suitable in the effort to protect children with cancer.
The key points emphasized in his letter included the following:
- Some available data suggest that adults with cancer are at increased risk of COVID-19. Measures proposed to protect adult patients from infection have included delay or postponement of therapy and prioritization of patient groups for hospital admission.
- Although children infected with COVID-19 appear to be less likely to develop severe illness than adults, there are now data indicating that infants and younger children (ie, age ≤ 5 years) are more likely to develop severe manifestations compared with older children (ie, age ≥ 6 years), with a potential explanation being the relative immaturity of the immune system in younger children.
- However, risk of severe COVID-19 infection may be increased in immunocompromised children with cancer; increased morbidity and mortality in imunocompromised children have been observed with other viral infections, including infection with other human coronaviruses.
- Most childhood cancers have an aggressive course and require immediate treatment, often involving prolonged durations of intensive multiagent chemotherapy. In many children, the postponement of therapy suggested for some groups of adults with cancer is not an option in the treatment of children.
- Isolation is a critical measure in limiting spread of infection, and inpatient isolation is standard practice for children receiving intensive chemotherapy or stem cell transplantation. However, most children with cancer are treated in the outpatient setting, with hospital visits and intermittent hospital admission being unavoidable for proper care.
- Guidance for reducing the risk COVID-19 transmission to children with cancer has been formulated by national and regional authorities (eg, the Australian & New Zealand Childrens Haematology/Oncology Group’s “COVID-19 Guidance and FAQ for children and young people undergoing cancer treatment”). Recommendations include emphasizing the importance of families adhering to standard precautions for basic and respiratory hygiene and avoidance of sick contacts. They also stress social distancing; this includes minimizing the number of people visiting oncology departments and postponement of or use of telehealth for noncritical outpatient visits, including for children in follow-up or survivorship clinics, in order to protect those children with cancer who require hospital visits. Recommendations must continue to evolve along with the COVID-19 crisis and as more is learned about the risk posed to pediatric patients with cancer.
Dr. Kotecha concluded, “The coming months will pose many further challenges, which might include accessibility to scarce resources, effects on drug manufacture and supply, and the effect on care of children with cancer from low-income and middle-income countries. Continued collaboration among the international pediatric oncology community is required to get through such uncertain times.”
Disclosure: For full disclosures of the study authors, visit thelancet.com.
