RESULTS:
The survey was sent to 96 Pediatric Hematologists-Oncologists across the
country while only 53 responded with a response rate of 50%. Out of the
53 responses, 50 responses were considered valid as per inclusion
criteria of responses from Pediatricians or Pediatric
Hematologist/Oncologists actively working in Pediatric
Hematology/Oncology in Pakistan. The respondents belonged to 14
different centers from all over Pakistan: 9 centers from the province of
Punjab, 4 from Sindh province (Karachi) and 1 center from
Khyber-Pakhtunkhua province (Peshawar). Currently there is no Pediatric
Hematology-Oncology center in the rest of two provinces of Pakistan
(Baluchistan and Gilgit-Baltistan).
Majority of the respondents (62%) were working in public sector
hospitals with availability of Pediatric Oncology, Pediatric Hematology
and/or Pediatric Bone Marrow Transplant facilities. Eighty two percent
Pediatric Hematologist/Oncologists were working in the hospitals where
COVID19 confirmed cases from general population were being catered. When
asked about the registration of new patients of PHO during pandemic,
14% (n=7) reported to have stopped registering new patients and 16%
(n=8) reported registering only selective patients. Reduced work load
during the pandemic was reported by 68% respondents, reduction in
number of patients coming for routine chemotherapies was reported by
64%, affected supportive care services for PHO patients were reported
by 78% while closure of various units of the PHO department (Outpatient
department, post-treatment follow up clinics, outpatient
transfusions/factor infusion clinics and high dependency unit) was
reported by 70% respondents.
A substantial number of pediatric hematologist/oncologists reported
having affected supplies of items that are commonly used in PHO units
including infection prevention and control supplies, chemotherapeutic
drugs, antibiotics, supportive care medicines and blood products (Table
1). The pandemic seriously affected important investigations needed to
diagnose and manage major hematological/oncological disorders,
multidisciplinary tumor boards, oncological surgeries, radiation
therapies, stem cell transplantation and teaching and training
activities of the post-graduate residents. Half of the clinicians (50%)
reported to have an institutional protocol available for the management
of immunocompromised COVID19 patients and mentioned about the screening
protocols and availability of COVID19 testing in pediatric
hematology/oncology patients. None of the participants reported any
confirm case of COVID19 among hematology/oncology patients or among
their staff members till date (April 27th 2020).
Satisfactory availability of PPE was reported. Regarding ability to
apply recommended measures for the prevention or management of COVID-19
in the pediatric oncology population7, 62%
respondents reported unavailability of isolated febrile neutropenia
rooms, 58% reported to be unable to exercise social distancing in ward
but 90% reported to be able to exercise short staff rosters with
extended holiday period during the pandemic.
In order to assess the level of personal and family health concerns
among the Pediatric Hematologists/Oncologists working during the
pandemic, a 1-4 Likert scale was used (1= Not concerned at all, 2=
Slightly concerned, 3= Moderately concerned, and 4= Deeply concerned).
Using the single sample t-test, the mean level of concern was calculated
and evaluated whether the mean score was significantly above or below
the mean (2.5). Significant levels of concern (M>2.5) were
reported by all of the pediatric hematologists/oncologists regarding
their personal health [M=3.26, SD=0.78, 95% CI=(3.04,3.48)] and
family health [M=3.64, SD=0.60, 95% CI=3.47,3.81)]. Similarly for
the assessment of extent of stress among them, a 1-5 Likert scale was
used (1= Not stressed at all, 2= To a small extent, 3= Somewhat
stressed, 4= To a large extent, and 5= Completely stressed out) and
significant level of stress (>3.0) was also reported
[M=3.00, SD=0.73, 95% CI=(2.79,3.20)] by all of the participants.