Division of Hematology-Oncology (Pelland-Marcotte, Larouche), CHU de Québec - Centre Mère-Enfant Soleil, Québec, Que.; Public Health Agency of Canada (Xie, Elkhalifa, Frechette, Kaur, Onysko), Ottawa, Ont.; C17 Council (Barber), Edmonton, Alta.; Division of Hematology-Oncology (Bouffet, Cohen-Gogo, Sung) and Program in Child Health Evaluative Sciences (Sung), Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ont.; Division of Pediatric Hematology/Oncology (Fernandez, Randall), IWK Health Centre, Halifax, NS; Division of Hematology/Oncology (Mitchell), Montreal Children's Hospital, Montréal, Que.; Division of Pediatric Hematology/Oncology/BMT (Rayar), BC Children's Hospital, Vancouver, BC; Jim Pattison Children's Hospital (Stammers), Saskatoon, Sask.; Pediatric Oncology Group of Ontario (Airhart), Toronto, Ont.; Department of Cancer Epidemiology and Prevention Research (Fidler-Benaoudia), Cancer Care Alberta, Alberta Health Services, Calgary, Alta.; Division of Hematology-Oncology (Gibson), McMaster Children's Hospital, Hamilton, Ont.
CMAJ. 2021 Nov 29;193(47):E1798-E1806. doi: 10.1503/cmaj.210659.
The COVID-19 pandemic has had a major impact on access to health care resources. Our objective was to estimate the impact of the COVID-19 pandemic on the incidence of childhood cancer in Canada. We also aimed to compare the proportion of patients who enrolled in clinical trials at diagnosis, presented with metastatic disease or had an early death during the first 9 months of the COVID-19 pandemic compared with previous years.
We conducted an observational study that included children younger than 15 years with a new diagnosis of cancer between March 2016 and November 2020 at 1 of 17 Canadian pediatric oncology centres. Our primary outcome was the monthly age-standardized incidence rates (ASIRs) of cancers. We evaluated level and trend changes using interventional autoregressive integrated moving average models. Secondary outcomes were the proportion of patients who were enrolled in a clinical trial, who had metastatic or advanced disease and who died within 30 days. We compared the baseline and pandemic periods using rate ratios (RRs) and 95% confidence intervals (CIs).
Age-standardized incidence rates during COVID-19 quarters were 157.7, 164.6, and 148.0 per million, respectively, whereas quarterly baseline ASIRs ranged between 150.3 and 175.1 per million (incidence RR 0.93 [95% CI 0.78 to 1.12] to incidence RR 1.04 [95% CI 0.87 to 1.24]). We found no statistically significant level or slope changes between the projected and observed ASIRs for all new cancers (parameter estimate [β], level 4.98, 95% CI -15.1 to 25.04, = 0.25), or when stratified by cancer type or by geographic area. Clinical trial enrolment rate was stable or increased during the pandemic compared with baseline (RR 1.22 [95% CI 0.70 to 2.13] to RR 1.71 [95% CI 1.01 to 2.89]). There was no difference in the proportion of patients with metastatic disease (RR 0.84 [95% CI 0.55 to 1.29] to RR 1.22 [0.84 to 1.79]), or who died within 30 days (RR 0.16 [95% CI 0.01 to 3.04] to RR 1.73 [95% CI 0.38 to 15.2]).
We did not observe a statistically significant change in the incidence of childhood cancer, or in the proportion of children enrolling in a clinical trial, presenting with metastatic disease or who died early during the first 9 months of the COVID-19 pandemic, which suggests that access to health care in pediatric oncology was not reduced substantially in Canada.
COVID-19 大流行对医疗资源的可及性产生了重大影响。我们的目标是评估 COVID-19 大流行对加拿大儿童癌症发病率的影响。我们还旨在比较在 COVID-19 大流行的前 9 个月与前几年相比，诊断时入组临床试验、出现转移性疾病或早期死亡的患者比例。
我们进行了一项观察性研究，纳入了 2016 年 3 月至 2020 年 11 月期间在 17 家加拿大儿科肿瘤中心的 15 岁以下新诊断癌症的儿童。我们的主要结局是癌症的每月年龄标准化发病率（ASIR）。我们使用干预自回归综合移动平均模型评估了水平和趋势变化。次要结局包括入组临床试验、出现转移性或晚期疾病以及 30 天内死亡的患者比例。我们使用率比（RR）和 95%置信区间（CI）比较基线期和大流行期。
COVID-19 季度的年龄标准化发病率分别为 157.7、164.6 和 148.0/百万，而季度基线 ASIR 范围为 150.3 至 175.1/百万（发病率 RR 0.93 [95%CI 0.78 至 1.12] 至发病率 RR 1.04 [95%CI 0.87 至 1.24]）。我们发现，所有新发癌症的预测和观察到的 ASIR 之间没有统计学上显著的水平或斜率变化（参数估计[β]，水平 4.98，95%CI -15.1 至 25.04，= 0.25），或按癌症类型或地理区域分层时。与基线相比，大流行期间临床试验入组率稳定或增加（RR 1.22 [95%CI 0.70 至 2.13] 至 RR 1.71 [95%CI 1.01 至 2.89]）。转移性疾病患者的比例（RR 0.84 [95%CI 0.55 至 1.29] 至 RR 1.22 [0.84 至 1.79]）或 30 天内死亡的患者比例（RR 0.16 [95%CI 0.01 至 3.04] 至 RR 1.73 [95%CI 0.38 至 15.2]）均无差异。
我们没有观察到儿童癌症发病率或入组临床试验、出现转移性疾病或在 COVID-19 大流行的前 9 个月内早期死亡的儿童比例发生统计学上显著变化，这表明加拿大儿科肿瘤学的医疗保健获得并未大幅减少。
