Treating Hematologic Oncology Patients in the Developing World During the COVID-19 Pandemic

Context The COVID-19 pandemic has caused healthcare and economic crisis in many countries globally. By 06/08/2020, the number of positive cases in Armenia were 13,325 (∼4,500 per million), with 211 lethal cases. Reports showed that patients with cancer are more vulnerable to COVID-19, and the above-mentioned affected cancer care directly, leading to practice changes. The situation is even more dramatic in developing countries. Objective The purpose of our study was to explore the challenges in hematologic oncology caused by the COVID-19 pandemic in Armenia. Design A survey was conducted at the only hematology institution in Armenia, Hematology Center after Prof. R.H. Yeolyan. Chairs of pediatric and adult hematology departments, two laboratories and a registry, epidemiologists, hospital pharmacy, and administration were interviewed. Results By 06/08/2020, at our institution, 161 PCR tests for COVID-19 were performed, with 13 (8%) positive results. Twelve (92%) positive cases were staff members (one clinical physician, one lab physicians, eight lab technicians, one ancillary worker), six (50%) were symptomatic, and none were hospitalized. Only one patient was positive, a 79-year-old female with chronic lymphocytic leukemia, who expired. Two pediatric patients with Hodgkin lymphoma have pneumonia, and the test results are pending. The main challenges we experienced were staff shortages (positive cases and that direct contacts with infected and elder staff were sent home) and supply chain disruptions and delays: reagents for MTX measurement were delayed for 3 months, HD-MTX infusions were postponed, and bone marrow biopsy single-use needles were non-available for a month. Dacarbazine has been unavailable for 1 month. Certain drugs and supplies increased in price: enoxaparin (2–3 times) and isopropyl alcohol (2×), and personal protective equipment has been in extreme shortage and increased in price (surgical masks more than 10×). Non-urgent visits were postponed and patients were managed mainly by phone. Patients paying out-off-pocket for chemotherapy medications experienced financial difficulties, and this affected the regimen choice. The average number of blood donors decreased by half, although free transportation was offered. Conclusions This is the first study from Armenia to show the challenges of hematologic oncology care during the COVID-19 pandemic in a developing country. Global attention is needed to alleviate the difficulties for these vulnerable patients.