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Pediatric oncologists find themselves in unprecedented demanding situations as a result of the COVID-19 pandemic. In Boston, a cancer institute still has evocative encounters with pediatric patients.
BOSTON, MASS. – In May 2020, what some call the peak of the pandemic, Allison F. O’Neill, MD, the disturbing sense of isolation surrounding the hallways and waiting rooms of the Dana-Farber Cancer Institute (Dana Farber) outpatient pediatric practice.
The room surrounded by thick plexiglass and invisible tape covered the floors, suggesting social distancing to separate patients and their families from others around the clinic.
“If you take a look at the pre-COVID era in the clinic, you had patients coming in combination exclusively in the resource room. They interacted with each other, there were no plexiglass separators, providers accumulated more in non-unusual spaces,” said O’Neill, Clinical Director, Solid Tumor Program, Pediatric Hematology/Oncology at Dana-Farber, in an interview with Targeted OncologyTM. and I only came and went when we saw patients. We had to orchestrate how we can spend a minimum of time with patients without exposing them.
For oncologists like O’Neill, even the way they looked at patients had changed. With increased use of telehealth, patients no longer arrived as in person. At Dana-Farber, experts have worked to make virtual visits operational seamlessly, to provide greater care to their patients while remaining socially distant.
“For a while, we served patients more in a virtual environment. We would skip the scales or scan them, but then do a virtual exam or verify that, if scans had been done, they were less likely at most to want a stop on the user unless they were clinically complex,” O’Neill said. excursion with a virtual tour, but it’s great to have the zoom option now.
Although more than 2 years have passed since the peak, there is very little institutional knowledge about pediatric cancer patients. 1
Surprisingly, the few studies that looked at COVID-19 in this patient population found that patients had a benign clinical course and low rates of asymptomatic carrying. This has allowed the care of pediatric oncology patients in active treatment to remain unchanged, as they can still get treatments, add chemotherapy courses delivered as planned, conditioning mobile stem transplants, etc.
“Our goal has been to celebrate the popular care we would have provided regardless of COVID. It was remarkable how many administrative meetings we had as normal. Everything was replaced every day, but it was replaced in real time and adapted. “. It was remarkable how temporarily we as a community were able to adapt to make sure we didn’t compromise on the quality of care,” O’Neill said.
While pediatric oncology patients may not have developed severe cases of COVID, there has been a sharp decline in diagnoses of new patients that correlated strongly at the time of quarantine.
“We’ve noticed a drop in new diagnoses, a delay in some diagnoses, and then a massive uptick, about a year and a half after COVID,” O’Neill added.
A study published in the American Society of Clinical Oncology Educational Book led by the Gerard C. study. Millen, MD, focused on how the care of children with cancer has been affected due to the COVID-19 pandemic. 2
“Pediatric oncology care is based on immediate assessment and diagnosis, referral to tertiary centers, subspecialized multidisciplinary teams, timely and coordinated multimodal therapy, and supportive care, all of which have been affected by the pandemic. Prioritizing COVID-19 patients, combined with lockdowns and limited transportation, has contributed to delaying and fragmenting care for children with cancer,” wrote the authors of the study led by Millen, UK Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, Faculty of Medical and Dental Sciences, University of Birmingham, Birmingham.
In the U. S. In the U. S. and around the world, patients and families were too nervous to seek treatment, adding to an impediment amid the pandemic. There were fewer emergency room visits from pediatric cancer patients, a relief in outpatient visits, a reduction in the hospital. and clinic hours, all of which may have influenced the timing of diagnoses for these patients. 2,3
In recent decades, clinical trials have played a role in obtaining better outcomes for children with cancer. But with health systems overwhelmed by the number of COVID-19 patients, there has been a delayed opening of new clinical trials and a limited backlog of existing trials. This highlighted the need to take into account vulnerable populations, adding young people with cancer.
During the first wave of the COVID-19 pandemic that lasted approximately between March 1, 2022 and April 30, 2020, trial recruitment was particularly affected, according to knowledge published in the Innovative Therapies for Children with Cancer consortium. 1 trial, 61% of phase 2 trials and 64% of molecular platform trials were closed for enrollment at at least 1 site, and 16% of additional sites stopped clinical trial enrollment for pediatric cancer patients. 3
Overall recruitment decreased by 61% from last year in 2019 and worryingly, there was also relief in site initiation visits and surveillance visits at the beginning of the pandemic, with 67% of site initiation visits and 64% of surveillance visits cancelled altogether. .
Not only is it not transparent at first whether cancer patients would be symptomatic or spread a complex disease, but the pandemic has also created many barriers to diagnosing patients and offering quality care to young people with cancer around the world.
“Fewer patients were registered over a consistent period of time because they could not register or were less interested in enrolling in trials because it meant more common visits or exposures. Now I think we’re looking at what we expect to be overall records consistent with a patient-consistent month,” O’Neill said. “There was a consistent period where, even if patients were enrolled in the trial, we couldn’t do the back-end studies that were related to learning more about how those patients respond to treatments and how their bodies responded. “
However, since this dramatic relief in recruitment for clinical trials, recruitment in the U. S. The U. S. and European Government has been strong, with enrollment expanding and patients coming in person.
“Now that we’re back in use regularly, a lot of that has been recovered. Fortunately, there are fewer delays in treatment, fewer barriers to enrolling patients in clinical trials, and fewer barriers to ongoing research,” O’Neill added.
All have been affected by the additional barriers created by the pandemic. For those in the pediatric oncology landscape, pediatric cancer providers and facilities have demonstrated resilience in these unprecedented times in the face of enormous obstacles.
“There is hope that the effects of the pandemic will lessen and that the adaptations it has imposed will provide greater long-term reach to the care of children with cancer,” Millen wrote in the study.
Still, little is known about the long-term consequences that can occur for those who have had COVID, including pediatric cancer patients. For both patients and providers, the impact of COVID-19 on overall survival and outcomes for children with cancer is unclear and concerning.
“We don’t know or perceive if there will be long-term consequences for COVID. There are several ongoing studies at Dana-Farber that read longitudinally about the RESPONSE to COVID from an immune attitude and longer-term follow-up with those patients, pediatric and adult, and if our cancer population is distinct from the cancer-free population or providers, then there are multiple cohorts in a row. There’s a lot to report and a lot to perceive when it comes to whether COVID has had an effect. the disease or general physical condition of our patient population. It will take some time to perceive it, but it has yet to have an effect on how we approach our patients’ care in the short term,” O’Neill said.
Now that vaccines are available to children, O’Neill urges his patients to get them because it will be to assess their price of protection in this patient population.
“We propose that our patients get vaccinated and we can function assuming that if they get COVID, we have so many treatments that we can give them except if there are patients who are exposed or if they are positive for COVID that can protect them, O’Neill said: “We are so fortunate to be in a different medical scenario than we had before, knowing that we have tactics to protect it, save it and treat our patients, if they have COVID positive, that we can operate closer. “to normality. “
Now, experts like O’Neill are focused on tactics to get their network up and running again. Although the social facets are not yet fully normalized, Dana-Farber’s physicians meet more in their work rooms, have lunch together, communicate fluently about patient care, socialize with their patients in their daily rounds, and mingle in the halltactics.
“It’s just a matter of trying to re-establish this collaborative high-level painting network that fosters each other and with new interns. As we return to this level of normalcy, we try to repair the true culture that makes painting so special. “For me, it’s been a challenge and something very important to recover from,” O’Neill added.