Written by: Matt Windsor
Media contact: Adam Pope
The largest registry of U.S. children with cancer diagnosed with COVID-19 found an increased risk of serious infection and adjustment of their cancer therapy because of COVID, underscoring the urgency of vaccinations for these children, the authors say. A new article in the Journal of Clinical Oncology shares findings from the largest registry of pediatric cancer diagnosed with COVID-19 in the United States. Based on data from 917 children treated in 94 U.S. institutions, researchers from the University of Alabama at Birmingham and colleagues found that “children with cancer and COVID-19 are at risk of developing a serious infection and needing their cancer therapy adjusted.” due to COVID infection, the authors write.
31% of registered patients were hospitalized 9% were admitted to ICU 4% died Cancer therapy was changed in 44.9% of children
The researchers also found that the children with cancer most likely to get sick with COVID-19:
patients 11 years of age or older patients with comorbidities (other health problems) patients with neutropenia and/or haematological malignancies
The data also showed that Hispanic children with cancer are more likely to be infected with SARS-CoV-2, the virus that causes COVID-19, than children of different ethnic backgrounds. Hispanic children are also more likely to have their cancer therapy modified because of an infection, even if they don’t appear to have a more serious disease course.
“Critical information for decision making”
“These findings provide critical information for decision-making among pediatric oncologists, including inpatient versus outpatient treatment of COVID-19, cancer therapy adaptations, consideration of monoclonal antibody therapy, and counseling of families on infection risks in the setting of the SARS-CoV-2 pandemic” , the authors write in SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities, published Oct. 25, 2021 in the Journal of Clinical Oncology.
“A key point of this research is that kids with cancer and COVID can get sick — they can end up in the hospital and ICU, and they can die,” said lead author Emily Johnston, MD, assistant professor in the Department of Pediatrics. Hematology-Oncology at the UAB Marnix E. Heersink School of Medicine and the UAB Institute for Cancer Outcomes and Survivorship. (In addition to her medical degree, Johnson has a master’s degree in health research.) “It’s important to do what we can to protect them from COVID, including vaccination and wearing masks. Now that childhood vaccinations have been approved, we will recommend them to our patients.”
In the early days of the COVID pandemic, many pediatric oncologists believed that children with cancer who were infected might outperform their healthy peers because of their suppressed immune systems. Most just wanted data to guide treatment decisions: Should children with cancer be hospitalized for observation if they are diagnosed with COVID-19? What did their colleagues do with the chemotherapy regimens? Were Certain Cancers Associated With Worse Outcomes?
Answering the big questions
“A key point of this research is that children with cancer and COVID can get sick – they can end up in the hospital and ICU, and they can die. It’s important to do what we can to protect them from COVID, including vaccination and wearing masks. Now that childhood vaccinations have been approved, we will recommend them to our patients.” — Emily Johnston, MD, assistant professor in the Department of Pediatric Hematology-Oncology at UAB Marnix E. Heersink School of Medicine and the UAB Institute for Cancer Outcomes and Survivorship.
Like many people, these doctors turned to their colleagues on social media to share what they had learned. “Physicians in New York and New Jersey discussed anecdotes of their experiences,” said Julie Wolfson, MD, senior author of the paper and associate professor in the UAB Division of Pediatric Hematology-Oncology and Institute for Cancer Outcomes and Survivorship. (Wolfson also has a Masters of Science degree in health research.) “So much of what we do as pediatric oncologists has to do with how intensive the treatment is. Intensity is related to outcomes, and it’s ingrained in us to stick to those treatment plans.”
In the United States, doctors wondered: How long should I wait to restart cancer treatment after a patient has been diagnosed with COVID? “Everyone kept saying, ‘Somebody should be collecting this data,’ and we decided we would,” said Wolfson, speaking of a group that started with themselves, Johnston and Jennifer Levine, MD, at Weill Cornell Medicine in New York. city . “UAB has a strong infectious disease department, the university prioritized COVID studies, we both have extensive research experience, and our institutional review board is used to outcome-based research, so it made sense to do this here.”
The researchers created the Pediatric Oncology COVID-19 Case Report Registry, or POCC, to “provide pediatric oncologists with real-time information about the clinical course of COVID-19 in children with cancer,” as they explain in their paper. Since the paper was submitted for publication, the registry has grown to more than 100 institutions and more than 1,300 patients.
Building the registry took “a lot of blood, sweat, and tears,” Wolfson said. “We sent emails to every Children’s Oncology Group program in the United States, everyone we had ever trained with, and posted them on social media. We thought it was the right choice to help the pediatric oncology community care for these children.”
The registry had three main purposes:
identify which children with cancer are most likely to get COVID-19 determine the clinical course of COVID-19 in children with cancer identify factors associated with a severe course of COVID-19
“If a child with cancer comes to an appointment with RSV or paraflu, we know what to do,” said pediatric oncologists, Wolfson said. “With COVID, nobody had the data.”
Differences in outcomes
“Everyone kept saying, ‘Someone has to collect this data’ and we decided we would do it. UAB has a strong infectious disease department, the university has prioritized COVID studies, we both have extensive research experience, and our institutional review board is used to outcome-based research, so it made sense to do this here.” — Julie Wolfson, MD, associate professor in the UAB Division of Pediatric Hematology-Oncology and the Institute of Cancer Outcomes and Survival.
The POCC registry data showed that children 11 years of age or older and children with other health conditions, neutropenia and hematologic malignancies all had worse outcomes than the rest of the registry cohort. That information is important, for example, when a doctor decides whether to hospitalize a patient for evaluation or order treatment with monoclonal antibodies, Wolfson says.
Wolfson and Johnston, both of whom have experience working with registry-based research, were also interested in differences in care and outcomes for children with cancer and COVID. “COVID has revealed many structural differences,” Johnston said. “The increased rates of COVID in Hispanic patients may be a reflection of who has essential jobs and lives in multi-generational homes.” These results have informed her own practice, Johnston added: “They have helped me do more informed counseling of families and encourage them to be extra careful with children with cancer.”
The research was originally unfunded, but has now received a grant from the Concern Foundation, a California-based nonprofit. In order to get answers as quickly as possible, the researchers did not collect patient identifiers, including health records, home addresses, and other data that would have required longer regulatory approvals at participating institutions. “We’re now starting to add that time information and other data,” Wolfson said. “We are already actively looking at subgroups of patients.”
“The other thing we want to explore is the system-level factors that helped some institutions participate, while other sites couldn’t,” Johnston said. “We want to understand the differences between these two types of sites.”
In addition to Johnston and Wolfson, who both treat patients at Children’s of Alabama, the authors of “SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities” are Isaac Martinez, Elizabeth S. Davis, Caroline Caudill, Joshua Richman, MD , Ph.D., and Smita Bhatia, MD, of UAB; Julienne Brackett, MD, of Texas Children’s Hospital; David S. Dickens, MD, of the University of Iowa; Alissa Kahn, MD, of Saint Joseph University Medical Center; Carla Schwalm, MD, of Bronson Methodist Hospital; Archana Sharma, DO, of the Rutgers Cancer Institute; Pratik A. Patel, MD, of Emory University School of Medicine; and Jennifer M. Levine, MD, of Weill Cornell Medicine.