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COVID-19 in Children with Cancer and Continuation of Cancer-Directed Therapy During the Infection. Indian J Pediatr 2022; 89:445-451. [PMID: 34378149 PMCID: PMC8354680 DOI: 10.1007/s12098-021-03894-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the experience with COVID-19 in children with cancer at the largest tertiary-cancer care and referral center in India. METHODS This study is a single tertiary center experience on COVID-19 in children with cancer and continuation of cancer-directed therapy in them. Children ≤ 15 y on active cancer treatment detected with COVID-19 until September 15th, 2020 were prospectively followed up in the study. Patients were managed in accordance with well-laid guidelines. Treatment was continued for children with COVID-19 who were clinically stable and on intensive treatment for various childhood cancers. RESULTS One hundred twenty-two children (median age 8 y; range 1-15 y, male:female 1.7:1) with cancer were diagnosed with COVID-19. Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%), and 6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35, and 60 d from diagnosis of COVID-19, respectively. Scheduled risk-directed intravenous chemotherapy was delivered in 70 (90.9%) of 77 children on active systemic treatment with a median delay of 14 d (range 0-48 d) and no increased toxicities. All-cause mortality rate was 7.4% (n = 9) and COVID-19 related mortality rate was 4.9% (n = 6). One hundred-fifteen (94.2%) children with COVID-19 did not require any form of respiratory support during the course of infection. CONCLUSIONS COVID-19 was not a major deterrent for the continuation of active cancer treatment despite persistent RT-PCR positivity. The long-term assessment of treatment adaptations requires further prospective follow-up and real-time addressal.
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Prasad M, Goswami S, Deodhar J, Chinnaswamy G. Impact of the COVID pandemic on survivors of childhood cancer and survivorship care: lessons for the future. Support Care Cancer 2022; 30:3303-3311. [PMID: 34985560 PMCID: PMC8727237 DOI: 10.1007/s00520-021-06788-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/30/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The COVID pandemic has greatly impacted cancer care, with survivorship care being accorded low priority. We aimed to assess the impact of the COVID pandemic on survivorship services at our centre, as well as on survivors of childhood cancer (CCS). METHODS We analyzed the trends in survivorship care at our centre from March 2020 to June 2021 compared to previous years. We also conducted an online survey of adolescent and young adult (AYA-CCS) following up at the After Completion of Treatment Clinic, Mumbai, to assess the impact of the COVID pandemic and ensuing restrictions on our cohort of survivors. Sibling responses were used as comparator (CTRI/2020/11/029029). RESULTS There was a decrease in in-person follow-ups and increase in remote follow-ups over the first few months of the pandemic. While in-person visits steadily increased after October 2020 and reached pre-pandemic numbers, distant follow-ups continue to be higher than pre-pandemic. Evaluable responses from the survey of 88 AYA-CCS and 25 siblings revealed new-onset health concerns in 29.5% of AYA-CCS, missed follow-up visit in 52% and varying degrees of mental health issues in 12.5%. While most survivors were able to cope with the stresses of the pandemic, 20% of siblings reported being unable to cope. CONCLUSIONS Survivorship services continue to be affected well into the pandemic, with increased use of distant follow-ups. While AYA-CCS experienced significant physical, mental health issues and psychosocial concerns as a result of the COVID pandemic, they coped better than siblings during this stressful time, possibly due to multiple, holistic support systems including family, peer support groups and healthcare team.
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Affiliation(s)
- Maya Prasad
- Division of Paediatric Oncology, Tata Memorial Centre, Parel, Mumbai, India, 400012.
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India.
| | - Savita Goswami
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
- Department of Psycho-Oncology, Tata Memorial Centre, Parel, Mumbai, India, 400012
| | - Jayita Deodhar
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
- Department of Psycho-Oncology, Tata Memorial Centre, Parel, Mumbai, India, 400012
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Parel, Mumbai, India, 400012
- Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
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Sharma J, Mahajan A, Bakhshi S, Patil V, Verma N, Radhakrishnan V, Singh A, Kayal S, Seth R, Pushpam D, Arora RS. The impact of COVID-19 pandemic on access to treatment for children with cancer in India and treating center practices. Cancer 2021; 128:579-586. [PMID: 34618361 PMCID: PMC8653392 DOI: 10.1002/cncr.33945] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic led the Indian government to announce a nationwide lockdown on March 23, 2020. This study aimed to explore the impact of the pandemic on the accessibility of care for children with cancer and to view strategies adopted by hospitals for service delivery. METHODS Weekly average of childhood cancer (≤18 years) patient registrations during pre-lockdown period (January 1 to March 23, 2020) were compared with post-lockdown period (March 24 to May 31, 2020). The effect on the scheduled treatment was investigated for post-lockdown period. A survey of health care providers was conducted to determine centers' adopted strategies. RESULTS In 30 participating centers, 1146 patients with childhood cancer (797 pre-lockdown period and 349 post-lockdown period) were registered. The weekly average registration was 67.3 and 35.5 patients during pre-lockdown and post-lockdown respectively (decline of 47.9%). Although most centers experienced this decline, there were 4 that saw an increase in patient registrations. The distribution of patients registered post-lockdown was found significantly different by age (lesser older age, P = .010) and distance (lesser travel distance, P = .001). 36.1% of patients, who were scheduled for any of the treatment modalities (chemotherapy, surgery, radiotherapy, and hematopoietic stem cell transplantation) during the post-lockdown period, experienced delays. Centers adopted several strategies including modifications to treatment protocols, increased use of growth factors, and increased support from social organizations. CONCLUSIONS This multicenter study from India suggests that the COVID-19 pandemic and the lockdown impacted 2 out of 3 children with cancer. The effect of this on survival is yet to be established.
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Affiliation(s)
| | | | - Sameer Bakhshi
- All India Institute of Medical Sciences, New Delhi, India
| | - Veerendra Patil
- Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | | | | | - Amitabh Singh
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Smita Kayal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rachna Seth
- All India Institute of Medical Sciences, New Delhi, India
| | - Deepam Pushpam
- All India Institute of Medical Sciences, New Delhi, India
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Kiwumulo HF, Muwonge H, Ibingira C, Kirabira JB, Ssekitoleko RT. A systematic review of modeling and simulation approaches in designing targeted treatment technologies for Leukemia Cancer in low and middle income countries. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:8149-8173. [PMID: 34814293 DOI: 10.3934/mbe.2021404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Virtual experimentation is a widely used approach for predicting systems behaviour especially in situations where resources for physical experiments are very limited. For example, targeted treatment inside the human body is particularly challenging, and as such, modeling and simulation is utilised to aid planning before a specific treatment is administered. In such approaches, precise treatment, as it is the case in radiotherapy, is used to administer a maximum dose to the infected regions while minimizing the effect on normal tissue. Complicated cancers such as leukemia present even greater challenges due to their presentation in liquid form and not being localised in one area. As such, science has led to the development of targeted drug delivery, where the infected cells can be specifically targeted anywhere in the body. Despite the great prospects and advances of these modeling and simulation tools in the design and delivery of targeted drugs, their use by Low and Middle Income Countries (LMICs) researchers and clinicians is still very limited. This paper therefore reviews the modeling and simulation approaches for leukemia treatment using nanoparticles as an example for virtual experimentation. A systematic review from various databases was carried out for studies that involved cancer treatment approaches through modeling and simulation with emphasis to data collected from LMICs. Results indicated that whereas there is an increasing trend in the use of modeling and simulation approaches, their uptake in LMICs is still limited. According to the review data collected, there is a clear need to employ these tools as key approaches for the planning of targeted drug treatment approaches.
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Affiliation(s)
| | - Haruna Muwonge
- Department of Medical Physiology, Makerere University, Kampala, Uganda
| | - Charles Ibingira
- Department of Human Anatomy, Makerere University, Kampala, Uganda
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Gürcan M, Çelebi T, Turan S. Experiences of Turkish Parents of Hospitalized Children With Cancer During the COVID-19 Pandemic: A Qualitative Study. Oncol Nurs Forum 2021; 48:403-411. [PMID: 34142998 DOI: 10.1188/21.onf.403-411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the experiences of Turkish parents of hospitalized children with cancer during the COVID-19 pandemic. PARTICIPANTS & SETTING Participants were recruited at the pediatric hematology-oncology clinic of a university hospital in Turkey. A purposive sampling strategy was used to identify participants. Parents who had a child aged 0-18 years with cancer were eligible. METHODOLOGIC APPROACH This study was conducted using a descriptive qualitative research design. Semistructured individual interviews with 14 parents of children with cancer were used for data collection. Data were analyzed using the content analysis method. FINDINGS Two main themes with related subthemes were identified that revealed the lived experiences of parents of children with cancer. IMPLICATIONS FOR NURSING Pediatric oncology nurses can develop clinical practices that help parents to cope with anxiety about COVID-19. Nurses should share with parents current and valid information about the child's care during the pandemic. Future research should examine the experiences of children with cancer and their parents from different cultures during the COVID-19 pandemic.
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Mahajan A, Arora RS, Sahi PK, Gomber S, Radhakrishnan N, Bagchi B, Jain P, Kumar A, Singh A, Gupta H, Sharma S, Ahamad N, Bagai P, Kumar A. Shared care for children with cancer in India through social and healthcare partnerships during the COVID-19 pandemic. Cancer Rep (Hoboken) 2021; 5:e1486. [PMID: 34180154 PMCID: PMC8420228 DOI: 10.1002/cnr2.1486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background The COVID pandemic posed a challenge for the tertiary centers to continue treatment. Some tertiary centers were designated as COVID‐only hospitals, making it difficult for existing childhood cancer patients to continue their treatment at those centres. The need for shared care in childhood cancer was perceived by Cankids and its partnering childhood cancer‐treating centers in North and East India. Aim We aim to show how Cankids upscaled its shared care model to ensure that COVID designated hospitals connected with other hospitals who have to continue to provide care to childhood cancer patients in the pandemic and thus ensured the continuation of treatment for these patients. Methods and result The need assessment of the beneficiaries was done in discussion with the hospital of origin and destination hospital. The need for shared care was also discussed with the families and consent was taken before shifting their children. Cankids with the help of advisors identified cases of high risk that need immediate attention, proactive regular monitoring, and help in care planning with the perspective and recommendation of the multiple providers. The shared care unit came forward with reasonable and discounted packages for treatment. There was a total of five hospitals requiring shared care, and 55 children were supported from April to November 2020. The median age was 8 years and their hospital of origin are in Bihar, Uttar Pradesh, West Bengal, and Delhi. The expenditure on the treatment of the 55 patients was INR 61 61 636 ($ 84 843), with a median of INR 41765 (IQR 19491–174 129) on each patient. Total 291 trips for the transport were arranged and all the patients combined stayed 174 days at Cankids accommodation facility. Conclusion The shared care helped the patients access standard treatment and reduce the financial burden.
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Affiliation(s)
- Amita Mahajan
- Department of Pediatrics Oncology and Hematology, Indraprastha Apollo Hospital, Delhi, India
| | | | - Puneet Kaur Sahi
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Sunil Gomber
- Department of Pediatric, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - Nita Radhakrishnan
- Department of Paediatric Hemato-Oncology, Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida, Uttar Pradesh, India
| | - Basab Bagchi
- Department of Medical Oncology & Haematology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prachi Jain
- Department of Pediatric Oncology, Max Super Specialty Hospital, Vaishali, Delhi, India
| | - Arvind Kumar
- Department of Hemato-Oncologist, Buddha Cancer Centre, Patna, Bihar, India
| | - Avinash Singh
- Department of Hemato-Oncology, Paras HMRI Hospital, Patna, Bihar, India
| | - Haresh Gupta
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Sonal Sharma
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Nasim Ahamad
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Poonam Bagai
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
| | - Arvind Kumar
- Department of Medical Projects and Social Support Program, Cankids Kidscan, Delhi, India
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Nicastro E, Verdoni L, Bettini LR, Zuin G, Balduzzi A, Montini G, Biondi A, D'Antiga L. COVID-19 in Immunosuppressed Children. Front Pediatr 2021; 9:629240. [PMID: 33996683 PMCID: PMC8116542 DOI: 10.3389/fped.2021.629240] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression-if not associated with other elements of fragility-do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lucio Verdoni
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Rachele Bettini
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanna Zuin
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Biondi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
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Radhakrishnan V, Ovett J, Rajendran A, Kolluru S, Pai V, Gnanaguru V, Dhanushkodi M, Kalaiyarasi JP, Mehra N, Selvarajan G, Rajan AK, Karunakaran P, Kesana S, Sagar T. COVID19 in children with cancer in low- and middle-income countries: Experience from a cancer center in Chennai, India. Pediatr Hematol Oncol 2021; 38:161-167. [PMID: 33150828 DOI: 10.1080/08880018.2020.1831113] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Crowded outpatient clinics and common wards in many hospitals in low and middle-income countries predispose children, caregivers, and health care workers to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report on the clinical features and outcomes of 15 children with cancer at our center who tested positive for SARS-CoV-2. Five out of 15 patients were symptomatic, and one patient required intensive care and respiratory support. All the patients in the study have recovered from the SARS-CoV-2 infection without any sequelae and have resumed their cancer treatment.
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Affiliation(s)
- Venkatraman Radhakrishnan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Jerin Ovett
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Aruna Rajendran
- Department of Pediatric Hematology and Oncology, Institute of Child Health, Chennai, India
| | - Saikrishna Kolluru
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Vishwajeeth Pai
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Vijay Gnanaguru
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Manikandan Dhanushkodi
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | | | - Nikita Mehra
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Gangothri Selvarajan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Arun Kumar Rajan
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Parathan Karunakaran
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Sivasree Kesana
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
| | - Tenali Sagar
- Department of Medical Oncology (Pediatric Oncology Division), Cancer Institute (WIA), Chennai, India
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