1. DiGiulio, Sarah

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When COVID-19 first hit the United States in March of 2020, there was little information about what to do for children with cancer who got infected with the new virus. Should they continue to receive chemotherapy? Should the children be hospitalized for observation? In response, a group of six pediatric oncologists decided to set up a registry to track these patients to discover how they were treated and their outcomes. "We wanted to get a sense of what was happening with their chemotherapy and also get a sense of how sick they were getting," one of the oncologists Emily Johnston, MD, Assistant Professor in the Division of Pediatric Hematology-Oncology at University of Alabama at Birmingham, told Oncology Times.

Emily Johnston, MD. ... - Click to enlarge in new windowEmily Johnston, MD. Emily Johnston, MD

The result was the Pediatric Oncology COVID-19 Cancer Case Report, a collaborative effort of more than 100 cancer centers across the United States. The registry includes data on more than 1,400 children with cancer who have had COVID-19. The group has been regularly publishing reports of the data on the group's website. And in October, the first peer-reviewed analysis of the data was published online ahead of print in the Journal of Clinical Oncology (201; doi: 10.1200/JCO.21.00702).


Key findings in the report (which includes data on 917 children with cancer and COVID-19) include the following: the majority (64%) were symptomatic; 44.9 percent had their cancer therapy modified; 31.2 percent were hospitalized; 10.9 percent required respiratory support; 9.2 percent were admitted to the ICU; and 1.6 percent died due to COVID-19. Here's why Johnston says these findings are significant.


1 Do the findings have implications for how to treat and manage children with cancer who get COVID-19?

"One of the key findings is that kids with cancer and COVID can get sick. Overall, about a third of the kids with cancer and COVID-19 were admitted to the hospital. It's not benign in these kids and it's important to do what we can to protect them.


"And over half of these kids are getting their chemotherapy changed because of COVID-19. We have seen tremendous improvements in outcomes in pediatric oncology in the last few decades. And part of that has come because we have become more intense in our chemotherapy routines. We know that staying on time and giving treatment as prescribed is really important for overall survival for cancer. So I think we're all a little nervous about these kids who have had their cancer therapy delayed because of a COVID-19 infection and what that might mean for their long-term survival from their cancer.


"This information has helped us counsel families. We are able to use this data to talk to families about what they need to do so they can protect their child with cancer from COVID. When families are uncertain whether they should get vaccinated, this data shows that if their child with cancer gets COVID, that's a big deal-because they can get sick, end up in the hospital, end up in the ICU, have their chemotherapy changed, or potentially die. So these data help us tell families it is really important to get vaccinated.


"Also, we now have some information about the kids who are most likely to get sick from COVID-19 if they get it-older kids, kids with comorbidities, and kids with low blood counts when they are diagnosed with COVID are more likely to get sick. So pediatric oncologists are using this information to help decide for which children to continue chemotherapy and which children to delay treatment. For the younger kids with normal counts who don't have any other health factors, we can continue giving them their chemotherapy and not modify it just because of their COVID-19 diagnosis if they are otherwise doing clinically well."


2 Are there any other noteworthy findings to point out?

"The data continue to highlight disparities in our health care system. When we compare our cohort of kids with COVID and cancer with other cohorts of children with cancer (but without COVID-19), there were a lot more kids in our cohort who have public insurance or were underrepresented minorities. So it continues to highlight that there are disparities in the system that we need to address.


"And related, Hispanic kids with cancer with COVID-19 were more likely to have their chemotherapy changed when they got COVID compared with non-Hispanic White children. They actually were not more likely to get sick. So, we need to figure out why it was that Hispanic kids were more likely to have their chemotherapy changed. Getting a child with COVID to the hospital for clinic visits is really challenging because you need to have a caregiver who does not have COVID get them there. So maybe their chemotherapy was changed because of the inability to get to the clinic. There are a lot of different reasons we might have been modifying their chemotherapy more. But the data doesn't tell us why and we really need to figure that out."


3 As you continue to analyze data, what questions will be important to ask and answer?

"There are a number of ongoing projects that we're doing. One is looking at specific subgroups. For instance, kids with acute lymphocytic leukemia (ALL) in maintenance therapy frequently have less immunosuppression than other kids and are able to go back to school. We're trying to get information about how kids with ALL on maintenance therapy do with COVID-19, so that we can help better counsel those families about whether or not those children can safely return to school as the pandemic continues.


"We are collecting vaccination data and learning more about kids with cancer who are getting the COVID vaccine. Are they getting it? Are they having any reactions? We're also now collecting more personal health information so we can get more information about things like trends over time. Are we seeing more or less hospitalizations as time goes on? It might be less as we get better at treating this. It might be more as the Delta variant has arisen. We're trying to look at how all of this has changed over the pandemic."