RESULTS
Dr. Hasan Sadikin Hospital (RSHS) is a large referral hospital in West
Java, Indonesia with nearly 1,000 beds. The pediatric oncology service
serves a population of around 45 million, has a 32-bed capacity, and
sees 300 to 400 new cases annually. Similar to other LMIC centers,
insufficient psychosocial and medical personnel and limited financial
assistance for families constitute major challenges. Abandonment of
treated has been identified as a significant cause of treatment failure
in the past. RSHS identified its first COVID-19 positive patient in
March, 2020. Stringent lockdowns were implemented between March and June
of 2020, with closure of public spaces and businesses and severe travel
restrictions. Elective surgeries were postponed and limitations on
outpatient clinics imposed.
A retrospective cohort design with two cohorts was used. The first
comprised of patients with childhood cancer admitted to RSHS before and
during the COVID-19 pandemic (November 2019–May 2020). Both newly and
previously diagnosed patients were included. A comparison cohort
(November 2018 – May 2019) was also identified comprising all analogous
patients a year before the pandemic. The number of new diagnoses was
determined through hospital databases. Abandonment was defined as
failure to start or continue scheduled curative-intend treatment for
four or more consecutive weeks3, excluding patients
transitioning to palliation, and was determined monthly through review
of medical charts. Outcomes were compared between cohorts using Poisson
regression (rate of new diagnoses) and Fisher’s exact tests (monthly
abandonment rate). Two tailed p-values less than 0.05 were considered
statistically significant at 95% confidence. The study was approved by
the RSHS research ethics board. Compared to the prior
year, the rate of new childhood
cancer diagnoses decreased by over 40%
[rate ratio 0.57,
95th confidence interval (CI) 0.41-0.79)]. Monthly
abandonment rates are shown in Table 1. No differences in abandonment
were seen in November through March. However, a trend towards higher
abandonment was seen in April 2020 as compared to April 2019 (12.8% vs.
8.6%; p=0.06); a substantial and statistically significant increase was
seen in May 2020 (14.8% vs. 6.7%; p<0.001).