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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 353-354

Coronavirus disease-2019 and childhood cancers in developing countries: A hurdle in the hope to attain the WHO 2030 targets?


1 Department of Paediatrics and Child Health, University of Health and Allied Sciences, Volta Region, Ghana
2 Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana

Date of Submission16-May-2020
Date of Decision16-May-2020
Date of Acceptance17-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Kokou Hefoume Amegan-Aho
Department of Paediatrics and Child Health, University of Health and Allied Sciences, PMB 31, Ho, Volta Region
Ghana
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_203_20

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How to cite this article:
Amegan-Aho KH, Salifu N. Coronavirus disease-2019 and childhood cancers in developing countries: A hurdle in the hope to attain the WHO 2030 targets?. Cancer Res Stat Treat 2020;3:353-4

How to cite this URL:
Amegan-Aho KH, Salifu N. Coronavirus disease-2019 and childhood cancers in developing countries: A hurdle in the hope to attain the WHO 2030 targets?. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 18];3:353-4. Available from: http://www.crstonline.com/text.asp?2020/3/2/353/287243



Amid limited data, enough evidence has been gathered in developing countries to understand the challenges in diagnosing and managing childhood cancers. Consequently, new partnerships have been formed aiming to turn the gloomy picture into a glowing one.[1] Therefore, there is hope that we may get closer to the target of 60% childhood cancer survival rate by 2030 in countries that report hardly more than 20% long-term survival.[2]

Suddenly, the coronavirus disease-2019 (COVID-19) pandemic has emerged and has been projected to impact developing countries the most.[3] In response to this threat, the in-country activities and international exchanges have drastically slowed down. As new information is trickling in, we now know that children are not immune to this infection. Apart from the direct danger posed by the infection to the vulnerable pediatric population,[4] will it undo the progress made in childhood cancer management in the developing countries?

This pandemic poses a risk of further widening the gap in the management of childhood cancers between the developing and developed countries.[1]

Saroha and Moulik, in their opinion paper, have elegantly discussed those risks and suggested practical steps to mitigate them.[5] Issues such as limited access to healthcare facilities, delay in diagnosing new cases, relatively increased workload, avoidance of essential treatment components, rationalization of supportive care, shortage of drug supply, reduced support from partners, and difficulty to start or continue clinical trials have been thoroughly discussed.[5],[6] Similar to international recommendations,[3] the authors have shared their mitigation measures, such as scaling down of intensive treatment whenever possible, prioritizing supportive care, delay or cancellation of procedures or treatment that are not critical in the short term, and using telephonic consultations.[5]

In our opinion, other challenges that need to be addressed are:

  • Limited access to healthcare because of a reduction in the caregivers' purchasing power due to low economic activities
  • The diversity of symptoms of COVID-19 among children may confuse the primary healthcare personnel, who may miss the diagnosis of childhood cancers, especially in areas where personnel knowledge on the topic is already low
  • Pediatric oncology staff are diverted toward the care of patients with COVID-19 and are stationed away from their healthcare facility, thus compounding the staff shortage
  • Increase in substandard medicines for cancer and supportive care in the developing countries on account of shortages due to major disruptions in production and supply chain
  • The reduction in the numbers of voluntary donors may increase the risk of transfusion-related infections due to lapses in transfusion safety procedures
  • Continued restrictions in economic activities may collapse businesses, thus endangering critical fund-raising activities, which many pediatric oncology units/centers in the developing countries heavily rely on to operate.


However, with these challenges may also come some opportunities. Perhaps, it is time to gather more evidence for improved, cost-effective treatment approaches, such as risk stratification of febrile neutropenia, determining the safest lowest threshold for blood transfusion considering the existing high rate of childhood anemia in the general population, and most importantly, the impact of protocol modifications must be addressed to remove procedures/treatments that are of no significant benefit. Any change in the recommended therapies must be well documented and regular audits should be conducted to determine their impact on survival and the patients' quality of life.



 
  References Top

1.
Atun R, Bhakta N, Denburg A, Frazier AL, Friedrich P, Gupta S, et al. Sustainable care for children with cancer: A Lancet Oncology Commission. Lancet Oncol 2020;21:e185-224.  Back to cited text no. 1
    
2.
WHO. Global Initiative for Childhood Cancer. WHO; 2018. Available from: https://www.who.int/cancer/childhood-cancer/en/. [Last accessed on 2020 Jan 03].  Back to cited text no. 2
    
3.
Sullivan M, Bouffet E, Rodriguez-Galindo C, Luna-Fineman S, Khan MS, Kearns P, et al. The COVID-19 pandemic: A rapid global response for children with cancer from SIOP, COG, SIOP-E, SIOP-PODC, IPSO, PROS, CCI, and St. Jude Global. Pediatr Blood Cancer 2020;67:e28409. [doi: 10.1002/pbc.28409].  Back to cited text no. 3
    
4.
Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr 2020. [doi: 10.1001/jamapediatrics. 2020.1948]. [Ahead of print].  Back to cited text no. 4
    
5.
Saroha M, Moulik NR. COPING with CORONA: A developing country perspective on managing children with cancer during COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:97-101.  Back to cited text no. 5
    
6.
Mathrudev V, Goud S, More S, Jain S. Impact of COVID-19 on oncology clinical trials: A “novel” challenge. Cancer Res Stat Treat 2020;3 Suppl S1:133-5.  Back to cited text no. 6
    




 

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