Impact of COVID-19 on Clinical Outcomes and Care Delivery in Pediatric Oncology Patients in Lebanon in 2020-2023: A Retrospective Study

Peter Noun^1,2*May Farhat³Hassan Khalife⁴Jennifer Bou Younis⁵Mohamad Farhat¹Hadi Kabbout⁶Hammam Haridy⁷Jihane Moussa⁷Florence Lefebvre D'hellencourt⁷Srinivas Rao Valluri⁷Julia Spinardi⁷Nadine Al Akoury⁷Moe H Kyaw⁷Adlette Inati^8,9*

• ¹Division of Pediatric Hematology and Oncology, Saint George Hospital University Medical Center, Beirut, Lebanon
• ²Saint George University, School of Medicine, Beirut, Lebanon
• ³Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
• ⁴Department of Pediatrics Hematology Oncology, Sahel hospital Medical Center (Lebanese University), Beirut & Rai Hospital, Saida, Lebanon
• ⁵Department of Pediatrics, Hematology Oncology Lebanese University hospital Geitewi, Beirut, Lebanon
• ⁶Department of Pediatrics, Hematology Oncology CHU Notre Dame Des Secours, Byblos, Lebanon
• ⁷Scientific and Medical Affairs, Emerging Markets, Pfizer Inc., Collegeville, PA, United States
• ⁸LAU Gilbert and Rose-Marie Chaghoury School of Medicine, Byblos, Lebanon
• ⁹Division of Pediatric Hematology Oncology, NINI Hospital, Tripoli, Lebanon

The COVID-19 pandemic has significantly impacted the pediatric population worldwide, particularly those with comorbidities who often experience more severe outcomes. However, the effects of COVID-19 on pediatric oncology patients remain poorly understood. This retrospective observational study examined data from 85 pediatric oncology patients aged <18 years who tested positive for COVID-19 at five study sites across Lebanon from March 2020 to May 2023. Detailed demographic, clinical, treatment, healthcare resource utilization (HCRU), and disease outcomes were collected. Outcomes was summarized descriptively and two-sided 95% confidence intervals (CI) were calculated using the Clopper-Pearson method. There was 85 pediatric oncology patients diagnosed with COVID-19, with a mean age of 11.57 years. Of these, 72 patients (84.6%) had hematological malignancies and 13 (15.4%) had solid tumors. Thirteen patients (15.3%) had comorbidities. Treatment delays occurred in 61 patients (71.8%). Twelve patients (14.1%) required hospitalization, four of whom needed intensive care unit (ICU) admission, with ICU stays ranging from 1 day to 2 months. COVID-19 related mortality was 4.7%. COVID-19 was associated with changes or delay in oncological treatment. In addition, hospitalization, intensive care utilization and death were greater among pediatric cancer patients with COVID-19. Our findings highlight the importance of vaccination in pediatric oncology patients.