2020 年儿童癌症中的 SARS-CoV-2：一种不平等的疾病。
SARS-CoV-2 in Childhood Cancer in 2020: A Disease of Disparities.
机构信息
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
出版信息
J Clin Oncol. 2021 Dec 1;39(34):3778-3788. doi: 10.1200/JCO.21.00702. Epub 2021 Oct 25.
PURPOSE
The Pediatric Oncology COVID-19 Case Report registry supplies pediatric oncologists with data surrounding the clinical course and outcomes in children with cancer and SARS-CoV-2.
METHODS
This observational study captured clinical and sociodemographic characteristics for children (≤ 21 years) receiving cancer therapy and infected with SARS-CoV-2 from the pandemic onset through February 19, 2021. The demographic and clinical characteristics of the cohort were compared with population-level pediatric oncology data (SEER). Multivariable binomial regression models evaluated patient characteristics associated with hospitalization, intensive care unit (ICU) admission, and changes in cancer therapy.
RESULTS
Ninety-four institutions contributed details on 917 children with cancer and SARS-CoV-2. Median age at SARS-CoV-2 infection was 11 years (range, 0-21 years). Compared with SEER, there was an over-representation of Hispanics (43.6% 29.7%, < .01), publicly insured (59.3% 33.5%, < .01), and patients with hematologic malignancies (65.8% 38.3%, < .01) in our cohort. The majority (64.1%) were symptomatic; 31.2% were hospitalized, 10.9% required respiratory support, 9.2% were admitted to the ICU, and 1.6% died because of SARS-CoV-2. Cancer therapy was modified in 44.9%. Hispanic ethnicity was associated with changes in cancer-directed therapy (adjusted risk ratio [aRR] = 1.3; 95% CI, 1.1 to 1.6]). Presence of comorbidities was associated with hospitalization (aRR = 1.3; 95% CI, 1.1 to 1.6) and ICU admission (aRR = 2.3; 95% CI, 1.5 to 3.6). Hematologic malignancies were associated with hospitalization (aRR = 1.6; 95% CI, 1.3 to 2.1).
CONCLUSION
These findings provide critical information for decision making among pediatric oncologists, including inpatient versus outpatient management, cancer therapy modifications, consideration of monoclonal antibody therapy, and counseling families on infection risks in the setting of the SARS-CoV-2 pandemic. The over-representation of Hispanic and publicly insured patients in this national cohort suggests disparities that require attention.
目的
儿科肿瘤 COVID-19 病例报告登记处为儿科肿瘤医生提供了有关儿童癌症和 SARS-CoV-2 临床病程和结局的数据。
方法
本观察性研究从大流行开始到 2021 年 2 月 19 日，收集了正在接受癌症治疗且感染 SARS-CoV-2 的儿童（≤21 岁）的临床和社会人口统计学特征。将队列的人口统计学和临床特征与人群级别的儿科肿瘤数据（SEER）进行比较。多变量二项式回归模型评估了与住院、重症监护病房（ICU）入院和癌症治疗改变相关的患者特征。
结果
94 家机构提供了 917 名患有癌症和 SARS-CoV-2 的儿童的详细信息。SARS-CoV-2 感染时的中位年龄为 11 岁（范围，0-21 岁）。与 SEER 相比，我们的队列中西班牙裔（43.6%比 29.7%，<.01）、有保险（59.3%比 33.5%，<.01）和血液恶性肿瘤患者（65.8%比 38.3%，<.01）的比例过高。大多数（64.1%）有症状；31.2%住院，10.9%需要呼吸支持，9.2%入住 ICU，1.6%因 SARS-CoV-2 死亡。44.9%的癌症治疗方案发生改变。西班牙裔种族与癌症导向治疗的改变相关（调整风险比[aRR] = 1.3；95%置信区间[CI]，1.1 至 1.6]）。合并症与住院（aRR = 1.3；95%CI，1.1 至 1.6）和 ICU 入院（aRR = 2.3；95%CI，1.5 至 3.6）相关。血液恶性肿瘤与住院（aRR = 1.6；95%CI，1.3 至 2.1）相关。
结论
这些发现为儿科肿瘤医生提供了重要的决策信息，包括住院与门诊管理、癌症治疗方案的调整、考虑单克隆抗体治疗以及在 SARS-CoV-2 大流行期间就感染风险为患者家属提供咨询。在这个全国性队列中，西班牙裔和有保险的患者比例过高表明存在需要关注的差异。
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