Impact of the covid-19 pandemic on healthrelated quality of life and anxiety in pediatric hematology/oncology patients: A single egyptian center experience

Background: Since the World Health Organization declared coronavirus disease 2019 (COVID-19) pandemic, the strain on healthcare services affected patients suffering from various comorbidities and added to the psychological burden. Aims: To assess anxiety level and it's impact on the health-related quality of life (HRQoL) of pediatric Hematology/Oncology patients during the COVID-19 pandemic. Methods: A cross-sectional study on convenience sample of 292 children with chronic hematological/oncological disorders attending Alexandria University Children's Hospital with their parents/guardians available were included. Patients' recruitment was done from May to June 2020 during the peak of the pandemic in Egypt. A Three groups were included: Patients with bleeding/coagulation disorders, transfusion-dependent patients, and patients receiving chemotherapy. HRQoL was assessed using a validated Arabic version of Parent proxy-report of Pediatric Quality of Life Inventory TM (PedsQLTM 4.0 Generic Core Scales). Anxiety was assessed using the Arabic version of the Spence Children's Anxiety Scale (SCAS). The preschool (PAS) and parent versions of the scale (SCAS-P) were completed by the caregivers. The preschool anxiety scale was used to measure anxiety in children aged 2.5-6.9 years. Results: The mean age was 8.72 ± 3.66 years, 52.4% were males and 65.4% were transfusion-dependent patients. Almost 60% of children were aware of the pandemic and 60.3% had blood transfusion difficulties. Males had lower anxiety levels than females (p < 0.001), and transfusion-dependent patients had lower anxiety levels than patients receiving chemotherapy (p < 0.001). Children who were aware of the COVID-19 pandemic had lower anxiety levels than those who were not (p = 0.006), while those suffering from fewer clinic days had higher anxiety levels (p = 0.02). Anxiety significantly reduced the three HRQoL domains (p < 0.001). Summary/Conclusion: The present study demonstrated the degree of anxiety and HRQoL affection during the COVID-19 pandemic in children with chronic hematological/oncological diseases and malignancies. The anxiety score was highest in patients receiving chemotherapy, while the HRQoL was lowest in patients with bleeding/coagulation disorders. These findings help a better understanding of the psychological impact of the pandemic on the studied group as a crucial step in guiding policies and interventions to maintain their psychological wellbeing.