Impact of socio-behavioral measures implemented during the SARS-CoV-2 pandemic on the outcomes of febrile neutropenia episodes in pediatric cancer patients: a single center quasi-experimental pre-post study

Abstract

During COVID-19, public health measures including masks and social distancing decreased viral upper respiratory infections (URI). Upper respiratory infections are the most common infectious etiology for low-risk pediatric febrile neutropenia (FN). This single-center, quasi-experimental, pre-post study was designed to understand the impact of public health measures on FN admissions and outcomes in the general pediatric oncology population during the COVID (March 2020–February 2021) vs. pre-COVID era (January 2018–February 2020) and their respective respiratory seasons (November–February). Episodes were risk-stratified using a tool recommended by the Children’s Oncology Group. Descriptive and bivariate statistics were used to compare admission characteristics and outcomes. Comparing respiratory seasons, the Covid-era season had 60% fewer URI diagnoses (5/12), while high-risk episodes (63.6% [28/44] vs. 44.2% [23/52]) and intensive care admissions (18.2% [8/44] vs. 3.8% [2/52]) increased. Between eras, URIs were lower in the COVID-era (10.8% [16/148] vs. 19.9% [67/336]; p = 0.01), but admission characteristics and severe outcomes were not different. The impact of public health measures was most prominent during the respiratory season. Despite decreased incidence of URIs, the overall admission characteristics and severe outcomes were minimally impacted due to the brevity of respiratory seasons, but larger studies are warranted.

Keywords:

• Cancer
• children
• COVID
• febrile neutropenia
• supportive care
• upper respiratory infection

Contribution statement

All authors equally contributed to the study. CNN and VC conceptualized the study. CNN drafted the manuscript, performed literature review and data collection, assisted in interpretation of data, and assisted in editing of report. TB performed data analysis and assisted with interpretation of data. SWC, VC, and RM assisted with interpretation of data, editing of report, and oversaw conduct of the study.

Disclosure statement

SW Choi is supported by the Edith S. Briskin and Shirley K Schlafer Foundation. SW Choi is supported by grants R01CA249211 and K24HL156896. T Braun is supported by grant P30CA046592.

Additional information

Funding

CN Nessle is supported by National Cancer Institute T32-CA236621: Interdisciplinary Research Training in Cancer Care Delivery grant