On January 31st, 2020, the World Health Organization declared a public health emergency. Less than two months later, on March 11th, the WHO officially declared the COVID-19 outbreak a pandemic. Since then we have all been experiencing on and off lockdowns and our whole lives changed. We all had to get used to a new world filled with social distancing, masks, and new restrictions. This world, created and maintained for our safety, had many unfortunate detrimental side effects for mental health and physical well-being, one of which is a delay in life-saving pediatric cancer screenings.
Cancer is a leading cause of death for children and adolescents with over 400,000 children being diagnosed each year. While childhood cancers are hard to prevent, there are a few ways to improve the patient outcomes. The main and most effective way of improving survival is early diagnosis. Significant improvements can be made in the lives of children diagnosed with cancer by detecting it early and avoiding delays in care. When identified early, cancer is more likely to respond to effective treatment, cause less suffering, and the initial treatment used is often less expensive and less intensive. However, in the midst of the COVID-19 pandemic, childhood cancers are getting diagnosed later and later.
This change is not at the fault of the parents or doctors, but rather it is a side effect of the new pandemic restrictions that have been put in place. In April 2020, the American Cancer Society (ACS) issued recommendations that no one should go to healthcare facilities for routine (nondiagnostic) cancer screening until further notification. As of August 2020, American Society of Clinical Oncology (ASCO) guidelines still recommended postponing most cancer screening procedures to conserve health system resources and reduce patient contact with health care facilities. On top of these guidelines, many doctors’ offices require a negative COVID-19 test or a quarantine period before seeing patients and some offices are only taking telehealth visits. While the screening guidelines from the ACS and ASCO have been lifted, putting kids through a complicated process for an indefinite diagnosis can place a lot of burden on both the child and the parent. Subsequently, when the symptoms aren’t severe or even really noticeable, parents don’t take their kids to screenings in the middle of the pandemic.
On top of that, if a child’s pediatrician does suspect cancer, depending on the type, rarity, and severity, getting a proper diagnosis and treatment plan is a lengthy process. Children will likely first start at their pediatrician, and then go to an oncologist and specialists if necessary, each with their own COVID-19 restrictions. Through this process, a variety of tests could be ordered from a biopsy to scans to blood tests or even a spinal tap. All of this would also be occurring underneath an overarching fear that the family or vulnerable child could contract COVID-19 from hospital trips and doctors visits.
COVID-19 is a horrible illness that has taken many lives. And while the restrictions in place clearly keep our society at its healthiest in these times, safety from the disease calls for some serious sacrifices. We are all affected by little things like parties being cancelled or limiting grocery trips, but at a larger level, children in need of medical attention are put at risk in the current society we live in. In this new pandemic world, every action we take in a public or private setting comes at a cost analysis in regards to COVID-19. With childhood cancer screening, parents are faced with the decision of putting their child through a lengthy process of getting screened out of a chance they might be sick and risking COVID-19 exposure, or waiting out the pandemic till life returns to some level of normalcy. This pandemic hasn’t been easy on anyone, but something as life-altering as a cancer diagnosis can go unnoticed because of our preoccupation with COVID-19. We are living through history, but that doesn’t mean we should disregard the present.
By Mahi Kovvuru