Study finds higher risk of all-cause mortality among pediatric cancer patients in LMICs during the pandemic
During the first nine months of the COVID-19 pandemic, pediatric cancer patients from low- and middle-income countries were at higher risk of all-cause mortality than those in high-income countries, according to data presented at the AACR Annual Meeting 2022, held 8-13. April.
This study was simultaneously published in BMJ Open.
Childhood cancer, while rare, is the world’s second leading non-communicable cause of death in children. Research has shown that childhood cancer survival rates differ dramatically in low- and middle-income countries (LMICs) compared to high-income countries (HICs), explains the study’s presenter, Muhammed Elhadi, MBBCh, a physician at the University of Tripoli in Libya.
Cancer in children is often curable, but without the correct and timely diagnosis and treatment, they are too often fatal. More than 90 percent of childhood cancer deaths occur in LMICs, due to factors such as underdiagnosis and lack of access to effective therapies.”
Muhammed Elhadi, MBBCh, Physician, University of Tripoli, Libya
As the COVID-19 pandemic spread around the world, the same inequalities that plague many aspects of healthcare quickly became apparent. Elhadi and colleagues suspected that the pandemic disproportionately impacted childhood cancer services in LMICs and could subsequently contribute to poorer outcomes for children with cancer.
To evaluate the impact of the pandemic on childhood cancer care, researchers and clinicians from the Global Health Research Group on Children’s Non-Communicable Diseases Collaborative, led by Kokila Lakhoo, PhD, and Noel Peter, BMedSci, collected data from 91 hospitals and cancer centers around the world. They examined data from March to December 2020 from 1,660 patients who were younger than 18 years of age and who had been recently diagnosed with acute lymphoblastic leukemia, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, Wilms tumor, sarcoma, retinoblastoma, gliomas, medullablastomas, or neuroblastomas. . A total of 1,104 patients (66.5 percent) were from LMICs and 556 (33.5 percent) from HICs.
During the first 30 days of the study, 45 patients from the LMICs died, compared to two patients from HICs. The risk of all-cause death was 4.3 percent in LMICs, compared to 0.4 percent in the HICs. 90 days after the study started, 66 patients in LMICs had died, compared to 5 patients in HICs. The risk of all-cause mortality was 7.0 percent in the LMICs, compared to 0.9 percent in the HICs. After controlling for factors such as age, sex, weight, tumor grade and tumor stage, the researchers found that pediatric cancer patients in LMICs had 35.7 times the risk of all-cause death than those in HICs.
Researchers found that a total of 219 children had their cancer treatments delayed, interrupted, or modified as a result of the pandemic. Elhadi said that while the researchers were able to document canceled or delayed surgeries and changes to treatment modalities, they were unable to determine whether deaths were caused by COVID-19, cancer, or other causes. The researchers are now collecting data reflecting the results of the pandemic’s first year and are working to fully identify the causes of death, Elhadi said.
“This study illustrates the wide disparities that still exist in childhood cancer care, and the multiple effects the COVID-19 pandemic has had on health care systems around the world,” said Elhadi. “Our results underscore the need for a reassessment of healthcare resources.
“This pandemic has become the defining crisis of our generation, and its consequences could extend beyond the acute crisis and have far-reaching implications for the future. Understanding its true impact, learning important lessons and identifying vulnerabilities within the health systems helps us to develop solutions, which will also prove crucial on our path to equitable global pediatric oncology care,” concludes Elhadi.
Soham Bandyopadhyay, MA, BM, BCh, FRSPH, an academic physician at Oxford University Clinical Academic Graduate School and John Radcliffe Hospital and a contributing author to the study, noted that the study was conducted by students and clinicians volunteering in their leisure. “Our findings on the impact of the pandemic have been made possible thanks to people’s generosity of mind and action. We believe that more studies and advocacy movements are possible if we build on these strong foundations,” he said.
The limitations of the study are as follows: The study only included children who had already been diagnosed with cancer. Research suggests that the pandemic has led to many “missed” cancer cases, and these undiagnosed cases may mean that the true burden in LMICs is even greater than the study reports, the authors said. Also, the researchers did not have specific baseline survival data for all cancer centers involved in the study, as many had never participated in a large study. Finally, 18 percent of patients were lost to follow-up after 90 days.
American Association for Cancer Research