International Journal of Science Annals, Vol. 4, No. 2, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa SOCIAL AND BEHAVIORAL SCIENCES. Health Care Sciences ORIGINAL RESEARCH The Population-Based Study of Oncology Surgery Department Service During COVID-19 Pandemic in Indonesia Single Center Hospital AuthorsтАЩ Contribution: A тАУ Study design; Ardianti M.1 ABCDEF , Putra M. D. P.1 ABCDEF , Yarso K. Y.1 ACDE B тАУ Data collection; C тАУ Statistical analysis; 1 Sebelas Maret University, Indonesia D тАУ Data interpretation; E тАУ Manuscript preparation; F тАУ Literature search; G тАУ Funds collection Received: 23.11.2021; Accepted: 20.12.2021; Published: 25.12.2021 Abstract Background and The COVID-19 pandemic has posed an unprecedented threat to global Aim of Study: healthcare delivery. Moewardi Hospital was appointed by the government of Indonesia to be a COVID-19 one of regional hospital by June 2020. Other than COVID-19 cases, the hospital also provides care for other diseases which also provides care for oncology patients. The aim of the study: to assess the impact of the social restriction on oncology services in this hospital. Material and Methods: This study compares the number of patients undergoing oncology surgery in the Central Surgery Unit and the number of patients attending the Outpatient Surgical Oncology Unit in March to July 2020 with the number of patients in the same timeframe in the previous year (2019). Results: The number of oncology operations in the Central Surgery Unit of Moewardi Hospital declined substantially during the 5-month pandemic period compared to the same period in the previous year, 2019 (p<0.001). There was also a significant drop in the number of patients attending the outpatient surgical oncology clinic during the pandemic period compared to the previous year (p<0.001) The lowest number of oncology surgeries occurred in April 2020, which was 20 patients. The lowest number of patients visited was 170 outpatients in March 2020. Thyroid and skin cancer cases were the most notable decline in surgical oncology cases in the Central Surgery Unit. The largest number of outpatients in the outpatient surgical oncology clinic during the COVID-19 pandemic was mammae and thyroid cancer. Conclusions: There was a decline in surgical oncology activities, which culminated in a significant decrease in surgical oncology patients in the Central Surgery Unit and the patient visit to the Moewardi Hospital outpatient oncology clinic during the COVID-19 pandemic. Keywords: oncology, surgery, oncology patients, COVID-19, Moewardi Hospital Copyright: ┬й 2021 Ardianti M., Putra M. D. P., Yarso, K. Y. Published by Archives of International Journal of Science Annals DOI and UDC DOI https://doi.org/10.26697/ijsa.2021.2.7 UDC 616-079(594) Conflict of interests: The authors declare that there is no conflict of interests Peer review: Double-blind review Source of support: This research did not receive any outside funding or support Information about Ardianti Meirisa тАУ https://orcid.org/0000-0003-1329-141X; MD, Department of the authors: Surgery, Faculty of Medicine, Sebelas Maret University, Indonesia. Putra Muhammad David Perdana тАУ https://orcid.org/0000-0001-6012-1160; MD, Department of Surgery, Faculty of Medicine, Sebelas Maret University, Indonesia. Yarso Kristanto Yuli (Corresponding Author) тАУ https://orcid.org/0000-0003- 4514-4676; yarsaonko@gmail.com; Surgeon, Department of Surgery, Oncology Division, Faculty of Medicine, Sebelas Maret University, Indonesia. 31 International Journal of Science Annals, Vol. 4, No. 2, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Introduction On December 31st, 2019, Wuhan Municipal Health oncology services in this hospital (both surgery and Commission, China, reported a cluster of cases of outpatient departments), we compared the number of pneumonia of unknown origin in Wuhan, Hubei province oncology surgeries and outpatient visits to the oncology (Taylor & Johnson, 2020). The case was later identified department in our hospital during 2 periods, the first 5 as the novel strain of coronavirus. On January 5th, 2020, months early lockdown period and the same periods in World Health Organization (WHO) published the first the previous year (2019). disease outbreak on the new virus. Coronaviruses are a The aim of the study. To assess the impact of the social large family of viruses that cause illnesses ranging from restriction on oncology services in this hospital. the common cold to more severe disease. The new virus was then named the тАЬCOVID-19 virusтАЭ. It may enter the Materials and Methods host through the respiratory tract or mucosal surface We conducted a comparison study on the oncology (such as conjunctiva). Symptoms usually begin with service between two periods: during the first 5 months of nonspecific syndromes, including fever, dry cough, and the early COVID-19 pandemic and on the same period in fatigue. Multiple systems may be involved including the previous year. We examined the number of oncology respiratory, gastrointestinal, musculoskeletal, and surgeries and outpatient visits from March to July 2020 neurologic (Sharma et al., 2021; Wu et al., 2020). and compared it with the same month in the year 2019. It was not until early March 2020 did WHO announce the The number of surgeries and outpatient visits was then COVID-19 as a pandemic, the same month the COVID- analyzed separately. Data were obtained from the 19 first case was announced in Indonesia by the President medical records of the oncology surgeries and outpatient of Indonesia (Setiawaty et al., 2020). The cases were then visits. increased with the first local transmission occurred to a The mean surgeries and visits per month were then man 59 years old on March 11th, 2020. The virus mainly calculated for each case to find out the proportion of spread through direct means (droplet and human-to- surgeries and visits during the early pandemic period and human transmission). It can infect other people via the same timeframe in the previous year. The mean respiratory droplets when a patient coughs, sneezes, or difference was analyzed by comparing the mean of the even talks within six feet area. In response to the case total case between two periods. All statistical data were increase, the large-scale social restriction was then being analyzed using the independent sample t-test, performed applied to essential activities only. Visits to healthcare using the Statistical Package for the Social Sciences facilities and hospital admission were limited to urgent (SPSS) for Windows version 25.0. The results of the and emergency cases (Lotfi et al., 2020). difference between the number of oncology surgeries and The COVID-19 pandemic has posed an unprecedented the number of outpatient visits between the two periods threat to global healthcare delivery. To deal with infected were considered statistically significant if p<0.05. patients, hospitals that have a high volume of patients requiring critical care have redeployed staff and Results converted operating rooms into intensive care units Table 1 shows the results for the total number of surgical (Usman et al., 2021). Also, clinicians must balance oncology patients in both periods (2020 and 2019). standard cancer therapies with measures designed to limit Table 1 the spread of COVID-19. At the same time, health care The Number of Oncology Surgeries workers face many challenges, including shortage of Surgery resources (e.g., personal protective equipment), Month Year P value number excessive working hours, and psychological distress March 2019 164 <0.001 (Richards et al., 2020; Rocco et al., 2021). Patients in the 2020 59 current pandemic may prefer to postpone non-essential April 2019 107 <0.001 elective surgery due to the risk of contracting the disease 2020 20 while in the hospital. However, this fear may cause May 2019 129 <0.001 patients to delay seeking care for conditions that would 2020 28 otherwise be correctable or curable if presented earlier; June 2019 121 <0.001 loss of function and reduced life expectancy may be the 2020 32 result of delayed presentation and an untimely diagnosis July 2019 142 <0.001 (Soreide et al., 2020; Uimonen et al., 2021). 2020 64 Moewardi Hospital is one of the hospitals that was appointed by the government to be a COVID-19 one of There was a significant decrease in the surgical oncology regional hospital by June 2020. Other than COVID-19 patients during the COVID-19 pandemic compared to the cases, the hospital also provides care for other diseases previous year. The number was notably low in the month which also provides care for oncology patients. Several after the first COVID-19 case was announced in studies have reported the subsequent impact of hospital Indonesia (April 2020), which was only a total of 20 visits and admission because of the measurement during patients of oncology surgeries compared to 107 patients pandemics (lockdown, social distancing, and restriction) in the same month the year before. The trend continued (Lotfi et al., 2020; Reichardt et al., 2020; Setiawaty et al., for few months and the number started to rise in June 2020).To assess the impact of the social restriction on 2020 (Figure 1). 32 International Journal of Science Annals, Vol. 4, No. 2, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa Figure 1 Discussion The Difference of Oncology Surgeries Between Two The first two confirmed cases of COVID-19 in Indonesia Periods was announced by the President of Indonesia on March 2nd 2020 (Lotfi et al., 2020). The cases then continued to Number of Surgeries 150 rise as the government conduct the testing and tracing, 125 and in response to the growing number, the Indonesian 100 National Board for Disaster Management declared an 75 emergency period for 91 days, effective until May 29th, 50 2020. On March 31st, 2020, President Joko Widodo declared a public health emergency and invoked the 25 police to enforce a large-scale social restriction policy as 0 stipulated by Law No.6/2018 on health quarantines March April May June July (Wiratraman, 2020). Because of this measure, people are Months encouraged to stay at home and avoid all unnecessary 2019 2020 activities including visits to the healthcare (GP practice, The same trends show on the outpatient visits to primary healthcare, and hospital) for non-emergency Oncology Unit (Table 2). cases. In Moewardi Hospital, which is 1 of 3 COVID Table 2 regional hospitals. The bed capacity for COVID-19 The Number of Outpatient Visits patients has increase from 7 beds in March to 57 beds in Outpatient July 2020. Month Year P value Lack of effective mitigation strategies against COVID visits March 2019 589 <0.001 and implementation lockdowns to control the spread of 2020 170 infection aggravated the healthcare crisis. COVID has a April 2019 466 <0.001 major adverse impact on cancer care delivery globally. 2020 181 Therefore, a hospital policy is not to accept new patients May 2019 574 <0.001 except for emergency patients or those with life- 2020 238 threatening conditions. The hospital also has a policy on June 2019 592 <0.001 cancer patient care, in this case, the surgery schedule 2020 293 (Usman et al., 2021). Our findings show that during the July 2019 557 <0.001 early pandemic period, especially the first two months 2020 290 after the first two cases were announced and the large- There was a significant decrease in the early pandemic scale social restriction was implemented, there was a period (March 2020) which was only 170 visits to the significant drop in the number of patient visits to outpatient oncology unit, compared to the year before oncology care in Moewardi Hospital (p<0.001). The which was 589 visits. The number of the visits gradually number of oncology surgery was the lowest in April rose and peaked in June 2020, and slightly decreased in 2020, after the hospital was appointed by the government July 2020, as seen in Figure 2. as COVID-19 referral hospital (by the end of March Figure 2 2020). These findings are in line with the study by Reichardt, et al (2020) which reported there was a highly The Difference of Oncology Outpatient Visits Between significant reduction in overall cancer admission in 75 Two Periods Helios hospitals in Germany for the early lockdown 600 period from March 13th to April 28th, 2020 compared to of Outpatient Visits the same period in 2019 (Reichardt et al., 2020). A study 500 by Mulholland et al. (2020) also had similar findings; Number 400 there were sharp drops in both emergency and planned hospital admission. A similar result was also found by 300 Stohr et al. (2020) who reported that there was a reduction in hospital admission following the 200 government-imposed social restriction, even for 100 emergency cases. Tzeng et al. (2020), reported that the high number of COVID-19 cases without symptoms was 0 an obstacle for reduction in hospital admission for cancer March April May June July sufferers. Months The significant decline in oncology surgeries patientтАЩs 2019 2020 visits might be due to the following reasons: 1) On the early pandemic year, people were encouraged There was a significant decline in the surgery numbers to restrict their visits to healthcare facilities. Despite the on 5 months pandemic period compared to the same unchanged oncology services in surgery and outpatient timeframe in 2019 (p<0.001), as seen in Table 1. departments, people delayed their surgery and outpatient Similar findings were shown in outpatient visits, which visit unless it's emergency cases; was showing a significant decline each month when compared between two periods. 33 International Journal of Science Annals, Vol. 4, No. 2, 2021 ╤Аrint ISSN: 2617-2682; online ISSN: 2707-3637; DOI:10.26697/ijsa 2) Furthermore, people might have been reluctant to visit pandemic. Hospital service protocols for COVID-19 and the hospital because they were afraid of contagion at the non-COVID-19 patients must be strictly defined, so that hospital; patients can receive medical care services according to 3) There was also adjustment in the hospital, such as their complaints. This is to prevent delays in diagnosis social distancing rules and COVID-19 screening before and treatment delays that increase patient mortality. surgeries, which subsequently affect patients who wanted to undergo their surgeries or visit the outpatient Acknowledgments department; The authors wish to thank to Dr. Akhmad Azmiardi for 4) The patients also began to seek alternatives in medical his suggestions on preparing the manuscript. assistance such as utilizing telemedicine or private home Ethical Approval care (Kumar & Dey, 2020). The study protocol was consistent with the ethical The risk of delay in carrying out health control and guidelines of the 1975 Declaration of Helsinki as treatment of cancer patients is estimated to be an increase reflected in a prior approval by the InstitutionтАЩs Human in the number of unresectable cancers as well as poor Research Committee. survival outcomes due to cancellations of follow-ups and postponements of surgeries (Stoss et al., 2021). 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E., Broggio, J., Loveday, C., Torr, B., outbreak of COVID-19: An overview. Journal of Garrett, A., Nicol, D. L., Jhanji, S., Boyce, S. A., the Chinese Medical Association, 83(3), 217тАУ220. Gronthoud, F., Ward, P., Handy, J. M., https://doi.org/10.1097/JCMA.0000000000000270 Cite this article as: Ardianti, M., Putra, M. D. P., & Yarso, K. Y. (2021). The population-based study of oncology surgery department service during COVID-19 pandemic in Indonesia Single Center Hospital. International Journal of Science Annals, 4(2), 31тАУ 35. https://doi.org/10.26697/ijsa.2021.2.7 The electronic version of this article is complete. It can be found online in the IJSA Archive https://ijsa.culturehealth.org/en/arhiv This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/deed.en). 35