Teleconsultations and Shared Care in Pediatric Oncology During COVID-19
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EDITORIAL COMMENTARY
Teleconsultations and Shared Care in Pediatric Oncology During COVID-19 Shuvadeep Ganguly 1 & Sameer Bakhshi 1 Received: 21 August 2020 / Accepted: 10 September 2020 # Dr. K C Chaudhuri Foundation 2020
The recent coronavirus disease-19 pandemic (COVID-19) presented a significant challenge in the effective care delivery for children with cancer across the globe. The data on clinical outcome of COVID-19 in childhood cancer patients is limited with very few cases severe enough to require intensive care [1]. Still, keeping in mind the immunosuppressive nature of anti-neoplastic therapy and our evolving understanding of the disease, pediatric oncology services have to tread carefully between treating cancer and limiting COVID-19 in this vulnerable population. With healthcare centres throughout the world grappling with COVID-19 pandemic with resource optimization, all aspects of cancer treatment were adversely affected, including ancillary services like blood product availability [2]. Drawing on the early experience in Italy, a consensus based guideline was formulated by International Childhood Cancer Organizations to adapt treatment strategy of childhood cancer patients keeping in mind resource limitations during the pandemic [3]. Our centre is a government tertiary care healthcare institution, which was also concurrently designated as a COVID-19 hospital during this pandemic. This led to manpower diversion thereby curtailing all aspects of non-COVID-19 healthcare services. India also simultaneously instituted lockdown measures early in the pandemic which led to further difficulty for parents/caregivers to access timely care. Our team formulated a multi-pronged strategy to adapt our treatment services considering these local challenges [4]. Initial triaging of patients and deciding intent of treatment was the cornerstone of the strategy. For children with palliative intent, hospital visits and intravenous chemotherapy were * Sameer Bakhshi [email protected] 1
Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
deferred as much as possible and oral metronomic therapy was administered wherever feasible [5]. We also adapted our chemotherapy protocols for various solid malignancies utilizing oral therapy and deferring hospital visits as a temporary measure especially for families living far away from hospital [6]. On the other hand, for aggressive malignancies like acute leukemia or Non-Hodgkin lymphoma (NHL) with curative intent, all efforts were made to institute or continue therapy according to protocol without any delay. Proper multidisciplinary co-ordination was maintained and life-saving surgeries with curative intent for disease like bone sarcoma were carried out with all proper precautions during this pandemic period [7]. We kept a significantly low threshold for testing any symptomatic patient for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and isolate any positive cases at the earli
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