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.