There are various factors related to delayed cancer diagnosis. One of them is accessibility to health resources,1 which were limited during the first year of the SARS-CoV-2 pandemic due to the reduction of healthcare activity in Primary Care Centres.2,3
A decrease in the incidence of cancer and detection in more advanced stages in the adult population was evident during the first wave of COVID-19.2,3 The scientific literature published on Paediatrics is scarce, although there are papers that report similar results.3,4 This study’s objective was to determine the impact caused by the SARS-CoV-2 pandemic on the detection of new oncological diagnoses in a Paediatric Emergency Department (PED).
We present a descriptive-observational study carried out in the PED of a tertiary mother and child hospital in Barcelona. Patients under 18 years of age with suspected new oncological diagnoses in the PED over 2 years (2019–2020) were included, and 2 groups were established according to the period in which they were seen: the year prior to the pandemic (period-1: 2019) and the year the pandemic started (period-2: year 2020). Cases in which the suspicion was not confirmed and those with a history of oncology in which relapse was diagnosed were excluded. The patients’ computerised medical records were reviewed after obtaining approval from the Hospital’s Ethics Committee (PIC-83-21).
175 cases were included: 83 in period-1 and 92 in period-2. The incidence of new cancer diagnoses was 0.8 cases per 1000 visits in the PED in period-1 and 1.2 cases per 1000 visits in period-2 (p = 0.003). A total of 132 (78.8%) patients had consulted with a healthcare unit due to the same symptoms prior to the visit to the PED. In 41 (23.4%) cases the debut was in the form of an oncological emergency: in 20 (11.4%) cases it was metabolic (14 tumor lysis syndrome, 6 hyperleucocytosis), in 20 (11.4%) cases it was mechanical (16 intracranial hypertension, 2 superior vena cava syndrome, 1 spinal cord compression and 1 tracheal compression) and in one (0.6%) case it was infectious (febrile neutropenia). The most common types of cancer were leukaemias (48; 27.4%), central nervous system tumours (48; 27.4%) and lymphomas (23; 13.1%). The median time to definitive diagnosis was 6 days (p25–75: 2–14 days). Table 1 shows the characteristics of the patients according to the year of the consultation.
Characteristics of patients with new oncological diagnosis (n = 175).
| Period-1: 2019 (n = 83) | Period-2: 2020 (n = 92) | p | |
|---|---|---|---|
| Age (years) | 4.5 (2.5–11) | 8 (3.5−13.5) | 0.149 |
| Sex male | 48 (57.8) | 44 (47.8) | 0.186 |
| Prior consultations | 69 (86.3) | 63 (70.8) | 0.015 |
| Oncological emergency | 13 (15.7) | 28 (30.4) | 0.021 |
| Metabolic | 8 (9.6) | 12 (13.0) | |
| Mechanical | 5 (6.0) | 15 (16.3) | |
| Infectious | 0 (0.0) | 1 (1.1) | |
| Suspicion-diagnosis time (days) | 6 (1–13) | 9 (2–15) | 0.115 |
Continuous variables are expressed as median and interquartile range and the categorical variables as counts and percentages.
In bold, statistical significance (p < 0.05).
This study shows that, during the first year of the pandemic, the number of new oncological diagnoses in the PED did not decrease but, the cases presented as an oncological emergency doubled. During 2020, a significant increase in the incidence of new oncological diagnoses were observed, in relation to the notable reduction in the number of consultations for other reasons. At the same time, this marked decrease in healthcare pressure in the PED could have contributed to an improvement in the quality of the diagnostic–therapeutic circuits of the patients seen. It is also worth noting that, unlike adults, children tend to be under closer observation by their parents and are therefore seen by a doctor sooner.1
Hyperleucocytosis, tumor lysis syndrome and intracranial hypertension were the main oncological emergencies diagnosed, with a third of these tumours showing the classic clinical presentation, coinciding with that reported in other studies.5 The increase in oncological emergencies could be related to the decrease in patients with previous medical consultations observed after the start of the pandemic. Difficulties in in-person access to the Primary Care Centres probably meant that patients consulted the PED directly when the child’s condition was more advanced.2,3,5 The time until diagnostic confirmation was the same in both study periods, reflecting that hospital activity in relation to cancer patients was effectively maintained.
The main limitation of this study is its retrospective nature. Information regarding medical care may have been lost, even though the medical records of these patients are usually well detailed.
In conclusion, although the beginning of the SARS-CoV-2 pandemic had little impact on the number of cases with new oncological diagnoses in the PED, an increase in emergency cases was observed. Once the suspicion was detected in the PED, the management of these patients did not differ from that previously established, with diagnostic confirmation being reached in a similar period of time.
FundingWork no funded.
Conflict of interestsThere are no conflicts of interest.
Cristina Larrosa Espinosa. Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona.
Rocío Matamoros López. Paediatric Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona.
Carles Luaces Cubells. Emergency Department, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Barcelona. Barcelona University, Barcelona. Influence of the environment on the well-being of children and adolescents, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Barcelona.
Paper approved by the Clinical Research Ethics Committee (CREC).
