Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country
ABSTRACT Background Measures to control COVID‐19 transmission disrupted childhood cancer care. Data on the effects of the COVID‐19 pandemic on childhood cancer mortality are lacking. This study describes the impact of the pandemic on childhood cancer early‐mortality (≤ 24 months). Methods A multicen...
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Wiley
2024-12-01
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| Online Access: | https://doi.org/10.1002/cam4.70483 |
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| author | Oscar Ramirez Vivian Piedrahita Santiago Bolivar Karina Grillo Adriana Linares Carlos Pardo Martha Piña Amaranto Suarez Carlos A. Portilla Jesus Ardila Viviana Lotero Luz A. Urcuqui Angela Trujillo Patricia Montenegro Luis E. Bravo Paula Aristizabal VIGICANCER Working Group |
| author_facet | Oscar Ramirez Vivian Piedrahita Santiago Bolivar Karina Grillo Adriana Linares Carlos Pardo Martha Piña Amaranto Suarez Carlos A. Portilla Jesus Ardila Viviana Lotero Luz A. Urcuqui Angela Trujillo Patricia Montenegro Luis E. Bravo Paula Aristizabal VIGICANCER Working Group |
| author_sort | Oscar Ramirez |
| collection | DOAJ |
| description | ABSTRACT Background Measures to control COVID‐19 transmission disrupted childhood cancer care. Data on the effects of the COVID‐19 pandemic on childhood cancer mortality are lacking. This study describes the impact of the pandemic on childhood cancer early‐mortality (≤ 24 months). Methods A multicenter prospective cohort was conducted in 10 Colombian cities. Children with newly diagnosed cancer registered in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) were included. Our primary outcome was cumulative mortality at 3, 6, 12, and 24 months. The exposed cohort (EC = March 25, 2020–December 31, 2021) was compared with a historic cohort (HC = January 1, 2017–March 24, 2020). Covariates included sociodemographics, place of residence, health insurance type, and tumor classification. Results The cohort included 4124 children, comprised of 1627 children in the EC and 2497 children in the HC. Hematolymphoid, central nervous system, and extracranial solid tumors represented 57%, 15%, and 28% of patients, respectively. Participants' median age was 6.7 years (IQR, 3.2–11.3), 54% were male, 7% were Afro‐descendant, and 47% had public insurance. In the EC, the 6‐month and 24‐month mortality adjusted hazard ratio (aHR) in children with solid tumors was 1.7 (95% CI, 1.1–2.7) and 1.3 (95% CI, 1.0–1.7), respectively, and in children with bone tumors 4.0 (95% CI, 1.2–13.0) and 2.1 (95% CI, 1.2–3.6), respectively. These associations persisted after accounting for metastatic disease. Six‐month mortality aHRs for retinoblastoma, bone tumors, and soft tissue sarcomas due to progressive disease were 4.3 (95% CI, 1.3–14.5), 4.0 (95% CI, 1.4–11.3), and 5.4 (95% CI, 2.2–13.5), respectively. In the EC, the adjusted odds ratio (aOR) for metastatic solid tumors vs. nonmetastatic was 1.4 (95% CI, 1.0–1.8) and in children with retinoblastoma and public insurance the 24‐month mortality aHR was 4.9 (95% CI, 1.1–21.7). Conclusions We observed increased early‐mortality for solid tumors, particularly bone tumors and retinoblastoma, likely attributed to more advanced‐stage presentation and loss of treatment effectiveness due to healthcare disruptions. Early‐mortality was higher in patients with public insurance, a vulnerable population that warrants attention. |
| format | Article |
| id | doaj-art-b55f2aa688d44da491eb7dc33b98bedb |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2024-12-01 |
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| series | Cancer Medicine |
| spelling | doaj-art-b55f2aa688d44da491eb7dc33b98bedb2025-01-20T10:51:32ZengWileyCancer Medicine2045-76342024-12-011324n/an/a10.1002/cam4.70483Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income CountryOscar Ramirez0Vivian Piedrahita1Santiago Bolivar2Karina Grillo3Adriana Linares4Carlos Pardo5Martha Piña6Amaranto Suarez7Carlos A. Portilla8Jesus Ardila9Viviana Lotero10Luz A. Urcuqui11Angela Trujillo12Patricia Montenegro13Luis E. Bravo14Paula Aristizabal15VIGICANCER Working GroupFundación POHEMA Unidad de Investigación Cali ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaFacultad de Medicina Pontificia Universidad Javeriana Bogotá ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaFundación HOMI‐Hospital Pediátrico la Misericordia Unidad de Oncología y Hematología Pediátrica Bogotá ColombiaFundación HOMI‐Hospital Pediátrico la Misericordia Unidad de Oncología y Hematología Pediátrica Bogotá ColombiaInstituto Nacional de Cancerología Unidad de Oncología Pediátrica Bogotá ColombiaInstituto Nacional de Cancerología Unidad de Oncología Pediátrica Bogotá ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaFundación POHEMA Unidad de Investigación Cali ColombiaClínica las Américas Auna, Instituto de Cancerología Las Américas Unidad de Oncología y Hematología Pediátrica Medellín ColombiaClínica Blas de Lezo Unidad de Oncología y Hematología Pediátrica Cartagena ColombiaRegistro Poblacional de Cáncer de Cali, Departamento de Patología Universidad del Valle Cali ColombiaDivision of Pediatric Hematology/Oncology, Department of Pediatrics University of California San Diego/Rady Children's Hospital San Diego San Diego California USAABSTRACT Background Measures to control COVID‐19 transmission disrupted childhood cancer care. Data on the effects of the COVID‐19 pandemic on childhood cancer mortality are lacking. This study describes the impact of the pandemic on childhood cancer early‐mortality (≤ 24 months). Methods A multicenter prospective cohort was conducted in 10 Colombian cities. Children with newly diagnosed cancer registered in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) were included. Our primary outcome was cumulative mortality at 3, 6, 12, and 24 months. The exposed cohort (EC = March 25, 2020–December 31, 2021) was compared with a historic cohort (HC = January 1, 2017–March 24, 2020). Covariates included sociodemographics, place of residence, health insurance type, and tumor classification. Results The cohort included 4124 children, comprised of 1627 children in the EC and 2497 children in the HC. Hematolymphoid, central nervous system, and extracranial solid tumors represented 57%, 15%, and 28% of patients, respectively. Participants' median age was 6.7 years (IQR, 3.2–11.3), 54% were male, 7% were Afro‐descendant, and 47% had public insurance. In the EC, the 6‐month and 24‐month mortality adjusted hazard ratio (aHR) in children with solid tumors was 1.7 (95% CI, 1.1–2.7) and 1.3 (95% CI, 1.0–1.7), respectively, and in children with bone tumors 4.0 (95% CI, 1.2–13.0) and 2.1 (95% CI, 1.2–3.6), respectively. These associations persisted after accounting for metastatic disease. Six‐month mortality aHRs for retinoblastoma, bone tumors, and soft tissue sarcomas due to progressive disease were 4.3 (95% CI, 1.3–14.5), 4.0 (95% CI, 1.4–11.3), and 5.4 (95% CI, 2.2–13.5), respectively. In the EC, the adjusted odds ratio (aOR) for metastatic solid tumors vs. nonmetastatic was 1.4 (95% CI, 1.0–1.8) and in children with retinoblastoma and public insurance the 24‐month mortality aHR was 4.9 (95% CI, 1.1–21.7). Conclusions We observed increased early‐mortality for solid tumors, particularly bone tumors and retinoblastoma, likely attributed to more advanced‐stage presentation and loss of treatment effectiveness due to healthcare disruptions. Early‐mortality was higher in patients with public insurance, a vulnerable population that warrants attention.https://doi.org/10.1002/cam4.70483bone neoplasmsCOVID‐19epidemiological monitoringhospitalmortalityneoplasms |
| spellingShingle | Oscar Ramirez Vivian Piedrahita Santiago Bolivar Karina Grillo Adriana Linares Carlos Pardo Martha Piña Amaranto Suarez Carlos A. Portilla Jesus Ardila Viviana Lotero Luz A. Urcuqui Angela Trujillo Patricia Montenegro Luis E. Bravo Paula Aristizabal VIGICANCER Working Group Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country Cancer Medicine bone neoplasms COVID‐19 epidemiological monitoring hospital mortality neoplasms |
| title | Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country |
| title_full | Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country |
| title_fullStr | Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country |
| title_full_unstemmed | Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country |
| title_short | Increased Early‐Mortality in Children With Solid Tumors During the COVID‐19 Pandemic in a Middle‐Income Country |
| title_sort | increased early mortality in children with solid tumors during the covid 19 pandemic in a middle income country |
| topic | bone neoplasms COVID‐19 epidemiological monitoring hospital mortality neoplasms |
| url | https://doi.org/10.1002/cam4.70483 |
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