RESULTS
Between April 21 and May 8, 2020, responses were obtained from 356 centers from 54 countries on six continents: Africa, Asia, Australia, Europe, North America, and South America (Fig 1). Table 1 lists the characteristics of the participating centers, which shows representation of various countries, type of cancer services, and capacity. The reported number of new patients with cancer served in the participating centers was 716,979 per year.
FIG 1  Number of the participating centers per country.
TABLE 1  Characteristics of Participating Centers Variable extent of service disruption was reported from some centers remaining fully functional as usual to others being completely closed. The majority of the centers (88.2%) reduced their usual level of care, and more than half (55.34%) of the reduction was a precautionary measure; however, in many cases, the disruption was due to other causes, such as an overwhelmed system (19.94%), staff shortage (17.98%), and lack of access to medications (9.83%; Table 2).
TABLE 2  Disruption of Cancer Care Services and Reasons for the Disruption Many patients missed chemotherapy sessions, with 46.35% of the centers reporting that more than 10% of their patients missed at least one session. As expected, many centers reduced their outpatient visits and switched to virtual clinics. Patients in many centers (58.15%) did not have the option of seeking care outside their centers. Participants reported the exposure of a significant fraction of patients to harm either from interruption of cancer-specific care or from interruption of care for other diseases (36.52% and 39.05%, respectively; Table 3). The reported harm estimates ranged from < 1% up to 80% of patients.
TABLE 3  Potential Harms to Patients Reported by Participants Cases of a confirmed COVID-19 diagnosis among patients were reported in 53.93% of the centers and among staff in 44.38% of the centers. Shortage of PPE was reported in multiple centers (48.31%). Physicians followed different guidelines for patient management and prioritization during the pandemic (Table 4).
TABLE 4  Diagnosis of COVID-19 and Infection Control Management Most centers implemented virtual clinics and virtual tumor boards (77.53% and 84.27%, respectively), and many believed that these changes will remain active beyond the pandemic. Remote care included performing routine laboratory tests close to patients’ homes and shipping medications to them (Table 5). At the time of completing the survey, only 16% of the centers reported that work is back to prepandemic baseline.
TABLE 5  Virtual Services and Remote Care Provided by Participating Centers During the Pandemic The severity of the pandemic impact on different aspects of care varied on the basis of the country level of income per World Bank stratifications, revealing a worse impact in centers of lower-resource countries. Lack of PPE, access to medications, and estimated exposure to harm was worse in lower-income countries. Furthermore, the centers in these countries were less likely to hold virtual tumor boards, run virtual clinics, do laboratory tests near patients’ homes, or deliver medications to patients (Table 6).
TABLE 6  Impact of COVID-19 Pandemic on Cancer Care Per World Bank Statification of Country Income Levels