The COVID-19 pandemic presents an unparalleled global challenge to the safe and effective care for children with cancer. There is an urgent need for health practitioners and families in this rapidly evolving and unpredictable situation with the standard treatment for cancer, while maintaining the health and safety of staff, patients and families.
For reasons so far unknown, children are reported to be far less affected than adults. Also, severity of the COVID-19 appears to be largely less when compared to that in adults. Children have been reported to be a potential asymptomatic reservoir of the disease. Most childhood cancers behave aggressively and need immediate treatment, often requiring prolonged periods of intensive multiagent chemotherapy. As such, postponing of therapy, which could be
considered on a case-by-case basis for adults with cancer, is not an option for children. Although isolation as an inpatient is common practice for children who are receiving intensive chemotherapy or stem cell transplant, most children with cancer are treated in the outpatient setting, and hospital visits or intermittent hospital admission is unavoidable for appropriate delivery of therapy.
Children, teenagers, and young adults undergoing cancer treatment have lowered immunity which could make it more difficult for them to combat infection such as COVID-19. As a parent or caregiver of a child, young or teen with cancer, it is important for you to take extra precautionary measures. The group of patients who are vulnerable to this infection includes:
Shielding is for the individuals (including children) at very high risk of coronavirus infection. Shielding measures should be used where an extremely vulnerable individual, with or without external assistance, resides in their own home. Some children remain at greater risk for COVID-19-infection and these children should be protected by ‘shielding’ as much as possible from infection.
Shielding measures include:
There are certain measures to be followed for pediatric cancer patients to avoid risk if COVID infection.
Pediatric oncologists should keep them updated on the prevention and control of COVID-19 infection in children with cancer. Some principles are paramount and should be considered for all children with cancer:
During this COVID-19 pandemic, children with high risk cancer represent a highly vulnerable population, especially when it comes to palliative care needs. In addition to their anxiety during the cancer diagnosis and treatment, these children are at increased risk for depression as well as psychological and emotional trauma due to suspicious symptoms of COVID-19 infection. Assisting with multifactorial pain, encouraging difficult decision-making and handling clinical confusion are central qualities of pediatric palliative care that are important to respond to the needs of certain patients and families.
Palliative care can help in early identification and treatment of physical, psychosocial, and spiritual distress to prevent and relieve suffering in patients with life-threatening illnesses and their families. The early integration of this approach is standard of care and must be instituted when a high-risk cancer is diagnosed and should continue throughout the course of illness, regardless of whether or not a child receives treatment directed at the disease. Children with cancer suffer from a distinct and significant symptom secondary to both the primary disease and the toxicities of treatment, and these adversely affect the quality of life for both patients and their families.
Palliative care can help in the early detection and management of physical, psychological, and social distress in order to prevent and relieve suffering in patients and their families with life-threatening diseases such as cancer. This approach is of great help when a patient is diagnosed with high-risk cancer. The care should continue throughout the course of treatment. Children with cancer suffer from a distinct and significant secondary symptom such as anxiety or depression along with primary symptoms of the disease which can affect the quality of life for both patients and their families. Thus, palliative care can be of great help in such situations.
COVID-19 is leading to increased demand for healthcare services. In these challenging times, it is important to incorporate palliative care into the ongoing treatment of children with cancer by encouraging early access to hospice and palliative care facilities, fostering awareness, and implementing policies and procedures that can be of great help on comfort and quality of life in the pediatric patients.
About Author –
Dr. K. Sreekanth, Consultant Surgical Oncologist, Yashoda Hospital, Hyderabad
MS, M.Ch (Surgical Oncology)
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