Pediatric cancer care has been negatively affected by the coronavirus disease 2019 (COVID-19) pandemic worldwide, resulting in decreased diagnoses, interrupted or delayed treatment, and treatment abandonment, according to the results of a cross-sectional study published in Lancet Child and Adolescent Health.1

“This effect appears to be unequal, disproportionately affecting pediatric oncology units in low-income and middle-income countries,” the authors wrote.

The number of reported cases of SARS-CoV-2 infection among pediatric patients with cancer has been low, but the effect of the pandemic on cancer care services is not well understood. The aim of this study was to evaluate the global effect of the COVID-19 pandemic on pediatric cancer care.

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The researchers conducted a cross-sectional study by distributing a survey between June and August 2020 to 311 pediatric oncology providers at 2013 institutions located in 79 countries.  The survey contained questions about the institution, patients diagnosed with SARS-CoV-2, changes or disruption to cancer care, and resources.

Respondents to the survey came from high-income (17%), upper middle-income (49%), lower middle-income (27%), and low-income countries (6%). The majority of respondents (70%) were pediatric hematologists/oncologist medical staff or unit directors, followed by infectious disease specialists (4%), physicians described as other type (12%), nurses or nurse directors (8%), trainees (3%), and other (3%). In 71% of cases, the institution was public or government based and the remaining were private or for-profit. SARS-CoV-2 testing was available at 88% of the institutions; 5% of institutions did not perform routine screening.

Overall, the COVID-19 pandemic resulted in changes to pediatric cancer care services. In rare cases, the pandemic resulted in complete closure of the institution or hematology/oncology services (7%) or new cases of suspected cancer were not being investigated (2%). A decrease in newly diagnosed pediatric cancer cases was reported by 43% of institutions, with no difference between institutions located in countries with different income status.

Treatment changes were frequently reported. Treatment abandonment, which was defined as failure to initiate treatment or a delay of at least 4 weeks in initiation, was reported by 34% of institutions. Reduced surgical care was reported by 72% of institutions, modifications to chemotherapy by 57%, and interruptions to radiotherapy by 28%. Blood product shortages were reported by 60% of institutions.

Institutions located in low-income to middle-income countries experienced significantly greater challenges with treatment services for their pediatric patients, regardless of institution or country level of COVID-19 cases. Compared with high-income countries, low-income to middle-income countries experienced greater unavailability of chemotherapy agents (P =.022), higher rates of treatment abandonment (P <.0001), and more frequent interruptions in radiotherapy (P <.0001).

In an accompanying editorial, it was noted that another study reported similar findings from Latin America.2 “In low-income and middle-income countries, including in Latin America, the common issues of late diagnosis and treatment abandonment or interruptions have worsened during the pandemic,” the author wrote.


  1. Graetz D, Agulnik A, Ranadive R, et al. Global effect of the COVID-19 pandemic on paediatric cancer care: a cross-sectional study. Lancet Child Adolesc Health. Published online March 3, 2021. doi:10.1016/S2352-4642(21)00031-6
  2. Fuentes-Alabi S. Effect of the COVID-19 outbreak on paediatric cancer care in low-income and middle-income countries. Lancet Child Adolesc Health. Published online March 3, 2021. doi:10.1016/S2352-4642(21)00058-4