TY - JOUR
T1 - Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic
AU - Global Health Research Group on Children's Non-Communicable Diseases Collaborative
AU - Bandyopadhyay, Soham
AU - Lakhoo, Kokila
AU - Abdelhafeez, Hafeez
AU - Wilson, Shaun
AU - Nagras, Sonal
AU - Sheth, Mihir
AU - Gandhi, Suraj
AU - Parwani, Divya
AU - Raj, Rhea
AU - Munezero, Diella
AU - Dutta, Rohini
AU - Roseline, Nsimire Mulanga
AU - McClafferty, Kellie
AU - Nazari, Armin
AU - Sriram, Smrithi
AU - Pillarisetti, Sai
AU - Nweze, King David
AU - Ashwinee, Aishwarya
AU - Kalra, Gul
AU - Patil, Poorvaprabha
AU - Nathani, Priyansh
AU - Bhullar, Khushman Kaur
AU - Elhadi, Muhammed
AU - Khan, Maryam
AU - Rahim, Nehal
AU - Madhusudanan, Shweta
AU - Erhabor, Joshua
AU - Shirke, Manasi
AU - Mughal, Aishah
AU - Au, Darica
AU - Salehi, Mahan
AU - Royyuru, Sravani
AU - Ahmed, Mohamed
AU - Hussain, Syeda Namayah Fatima
AU - Robinson, Daniel
AU - Casey, Anna
AU - Khan, Mehdi
AU - Dukundane, Alexandre
AU - Festus, Kwizera
AU - Govind, Vaishnavi
AU - Pancharatnam, Rohan
AU - Ochieng, Lorraine
AU - Taylor, Elliott H.
AU - Nautiyal, Hritik
AU - De Andres Crespo, Marta
AU - Charuvila, Somy
AU - Valetopoulou, Alexandra
AU - Zuberi, Hira
AU - Bwala, Kefas John
AU - Muthukumar, Akila
N1 - Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/10/19
Y1 - 2022/10/19
N2 - Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.
AB - Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer.
KW - COVID-19
KW - Cancer
KW - Health systems
KW - Paediatrics
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U2 - 10.1136/bmjgh-2022-008797
DO - 10.1136/bmjgh-2022-008797
M3 - Article
AN - SCOPUS:85142013900
SN - 2059-7908
VL - 7
JO - BMJ Global Health
JF - BMJ Global Health
IS - 10
M1 - e008797
ER -