Background: COVID-19, the novel coronavirus has caused a global pandemic affecting millions of people around the world. Although children, including children with cancer, have been found to be affected less commonly and less severely than adults, indirect effects of the pandemic on the diagnosis and treatment of children with cancer have been less described. Methods: A survey was performed in the four largest tertiary pediatric hematology-oncology medical centers in Israel. Clinical and laboratory data were collected from the medical files of patients diagnosed or treated with cancer during April-October 2020. Results: Seventeen patients are described, who had significant delay in diagnosis or treatment of cancer. These represent approximately 10% of all the pediatric cancer diagnosed during the study period in these centers. A main cause of delay was fear of exposure to COVID-19 (fears felt by the patient, parent, physician, or decision-makers at the institution; or the implementation of national guidelines). Delays also resulted from co-infection with COVID-19 and the attribution of the oncologic symptoms to the infection. In addition, treatment was delayed of patients already diagnosed with cancer, due to COVID-19 infection detected in the patient, a family member, or a bone marrow donor. Conclusion: Fear from the COVID-19 pandemic may result in delayed diagnosis and treatment of children with cancer, which may carry a risk to dismal prognosis. It is crucial that pediatricians and patients alike remember that other diseases still prevail and must be thought of and treated in a timely fashion.

A comprehensive literature search was performed of all databases of the Web of Science Citation Index, during 1990-2020, for the terms: neuropsychological, neurocognitive, cognitive, acute lymphoblastic (and lymphocytic) leukemia, and osteogenic sarcoma, to see if there was evidence of a correlation between folinic acid (FA) rescue inadequacy and long-term cognitive damage. All English language, peer-reviewed articles of neuropsychological assessments of children who had been treated with high-dose methotrexate without irradiation, and which included details of methotrexate and FA schedules, were selected. Four groups of studies were found and analyzed, Those with no evidence of cognitive deterioration, Those with evidence of cognitive deterioration, studies with more than one protocol grouped together, preventing separate analysis of any protocols, and those with significant serious methodical problems. In all studies, protocols without evidence of cognitive deterioration reported adequate FA rescue, and those with evidence of cognitive deterioration reported inadequate FA rescue.