The COVID-19 pandemic has greatly impacted pediatric oncology care, resulting in major staffing issues as well as physical, mental and financial pressure on those who care for children with cancer. But health care providers still managed to provide quality care to pediatric cancer patients, according to results published in American Cancer Society’s journal Cancer.

The pandemic and its associated restrictions and lockdowns interrupted care for children with cancer. Elizabeth Sniderman, MSN, of the St. Jude Children’s Research Hospital, and colleagues analyzed the effect of the pandemic on health care providers in pediatric oncology worldwide.

Between June and August 2020, the team conducted a survey to explore how clinical care and resources were altered and how this impacted providers. The researchers received responses from 311 clinicians who provide pediatric cancer care, including physicians, nurses, social workers, psychologists and more. The respondents represented 213 public and private institutions, 79 countries from all World Health Organization regions and all income levels. In addition, 16 institutions took part in 19 multidisciplinary focus groups conducted in eight languages.

Respondents from just over half of the institutions (51%) reported having been impacted by reduced clinical staff availability, and 66% cited a drop in provider availability. In some cases, roles or responsibilities changed, and some providers transferred to other specialties. About 45% of institutions transferred personnel to provide support for other services, and pediatric oncology units were sometimes repurposed or closed. Staffing modifications were more common in countries with higher COVID-19 incidence and mortality.

Half of the providers said they did not have the necessary personal protective equipment (PPE). Providers experienced COVID-19 illness, psychological distress and financial concerns; 8% reported losing colleagues to COVID-19. What’s more, nurses saw a greater impact than other providers.

“Worryingly, nurses were the most vulnerable group, with the highest illness rates, frequent quarantines and reassignments, PPE shortages and psychological distress,” Lorena Baroni MD, of Hospital JP Garrahan in Buenos Aires, and Eric Bouffet, MD, of the University of Toronto, wrote in an accompanying editorial. “Moreover, they were more affected by the financial impact, suffering from unexpected expenses, such as PPE purchases or increased transportation costs and unpaid leave for illness or quarantine.”

Some 46% of institutions provided mental health support, while 37% offered decreased support during the pandemic.

“Fear, guilt, anxiety and exhaustion were the most common feelings described by the health care system,” the editorial authors continued. “Despite these stressors, less than half of institutions provided psychological support to health care providers.”

With the help of the focus groups, the researchers found that greater teamwork and communication offset these negative effects. It also helped that providers contributed beyond the scope of their jobs and that policies that prioritized safety were put in place. Feeling like they were contributing to the pandemic effort also had a positive impact.

“COVID-19 had a profound impact on the pediatric oncology workforce, creating challenging modifications to staffing and resulting in physical, psychological and financial distress,” Sniderman and colleagues concluded. “Despite these challenges, health care providers caring for children with cancer came together to continue to provide high-quality care.”

“The stabilizing elements that we found to help mitigate the challenges of the pandemic included teamwork, communication, feelings of contributing and policies aimed at optimizing safety,” Sniderman said in a press release. “These factors should be enhanced and implemented by organizations to support providers during this pandemic and future health crises.”

Click here to read the study in Cancer.

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