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).