Impact of COVID-19 on cancer management in military hospitals of Saudi Arabia

Omar Al Zahrani; Ismail Ghorbel; Osama Mukhtar; Muneera Almajed; Hoda M. Abdelazim; Muhammad N. Hasan; Ahmad Mostafa; Aisha A. Al Harbi; Ali Bajouda

doi:10.15537/smj.2021.42.12.20210483

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Table 1

- Comparative analysis of demographic features between 2 samples (2019 and 2020).

Demographic characteristic	2019		2020		Chi square/Fisher statistics	P-value
Demographic characteristic	n	(%)	n	(%)	Chi square/Fisher statistics	P-value
Gender, n (%)
Male	380	(44.4)	322	(44.8)	0.033	0.857
Female	476	(55.6)	396	(55.2)	0.033	0.857
Eligibility, n (%)
Military	787	(92.8)	636	(89.0)	7.701	0.008
Non-military	61	(7.2)	79	(11.0)	7.701	0.008
Referred hospital, n (%)
Same	705	(84.5)	534	(76.2)	35.266	0.000
Other military	67	(8.0)	46	(6.6)
Other civilian	62	(7.4)	121	(17.3)
	Mean ± SD	Range	Mean ± SD	Range	T-statistics	P-value
Age	56.9±18.5	3-98	57.4±16.8	2-100	0.523	0.601

Total of some categories do not add to the total sample size such as “1574” due to some “missing data” in these categories. SD: standard deviation

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Table 2

- Comparison between the 2 samples (2019 and 2020) in terms of cancer sites.

Cancer type	2019		2020		Total
Cancer type	n	%	n	%	n	%
Breast	156	18.3	141	19.7	297	19.0
Colorectal	130	15.3	124	17.4	254	16.2
Thyroid	85	10.0	25	3.5	110	7.0
NHL	55	6.5	39	5.5	94	6.0
Corpus uteri	41	4.8	46	6.4	87	5.6
Prostate	49	5.8	25	3.5	74	4.7
Head and neck	27	3.2	39	5.5	66	4.2
Lungs	31	3.6	28	3.9	59	3.8
Gastric	22	2.6	29	4.1	51	3.3
Pancreas	24	2.8	26	3.6	50	3.2
Brain	21	2.5	26	3.6	47	3.0
Kidney	28	3.3	13	1.8	41	2.6
Ovary	21	2.5	15	2.1	36	2.3
Skin	21	2.5	14	2.0	35	2.2
Liver	16	1.9	14	2.0	30	1.9
Soft tissue	17	2.0	13	1.8	30	1.9
Bladder	12	1.4	16	2.2	28	1.8
Hodgkin lymphoma	12	1.4	6	0.8	18	1.1
Testicular	11	1.3	6	0.8	17	1.1
Leukemia	7	0.8	8	1.1	15	1.0
Esophagus	5	0.6	8	1.1	13	0.8
Bones	6	0.7	6	0.8	12	0.8
Multiple myeloma	5	0.6	4	0.6	9	0.6
Myeloproliferative neoplasm	2	0.2	6	0.8	8	0.5
Malignancy of unknown origin	5	0.6	3	0.4	8	0.5
Tongue	1	0.1	6	0.8	7	0.4
Others	42	4.9	28	3.9	70	4.5
Total	852	100	714	100	1566	100

Due to some missing information (data) of the diagnosis of the some malignant cases the totals do not add to the sample size.

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Table 3

- Comparison between the 2 samples (2019 and 2020) in time duration for acceptance and start of first oncology treatment.

Hospitals	KPIs	Year	n	Mean±SD	Median	z-scores	P-value
Overall combined	Time duration for acceptance of new cancer patient in oncology	2019	736	7.3±27.8	5.0	-1.299	0.194
		2020	635	8.0±25.4	4.0	-1.299	0.194
	Time duration to start first oncological treatment	2019	686	38.4±48.1	26.0	-0.464	0.643
	Time duration to start first oncological treatment	2020	574	44.3±67.9	25.0	-0.464	0.643
KFAFH Jeddah	Time duration for acceptance of new cancer patient in oncology	2019	128	8.4±35.9	0.0	-2.363	0.018
		2020	91	16.2±58.5	1.0	-2.363	0.018
	Time duration to start first oncological treatment	2019	154	22.6±40.2	11.0	-1.568	0.117
	Time duration to start first oncological treatment	2020	93	37.6±73.8	14.0	-1.568	0.117
KSAFH Tabuk	Time duration for acceptance of new cancer patient in oncology	2019	91	9.0±38.9	3.0	-0.741	0.459
		2020	126	5.2±7.2	3.0	-0.741	0.459
	Time duration to start first oncological treatment	2019	89	20.2±19.3	17.0	-0.780	0.435
	Time duration to start first oncological treatment	2020	115	17.8±18.0	14.0	-0.780	0.435
PSMMC Riyadh	Time duration for acceptance of new cancer patient in oncology	2019	361	8.1±22.9	7.0	-1.345	0.179
		2020	235	8.9±10.7	6.0	-1.345	0.179
	Time duration to start first oncological treatment	2019	343	44.1±51.0	30.0	-0.087	0.931
	Time duration to start first oncological treatment	2020	229	39.3±59.5	32.0	-0.087	0.931
AFHSR Khamis Mushait	Time duration for acceptance of new cancer patient in oncology	2019	58	4.4±4.4	2.5	-0.244	0.807
		2020	63	5.0±6.7	2.0	-0.244	0.807
	Time duration to start first oncological treatment	2019	23	11.4±22.0	1.0	-0.064	0.949
	Time duration to start first oncological treatment	2020	32	11.9±19.6	0.0	-0.064	0.949
AL HADA Taif	Time duration for acceptance of new cancer patient in oncology	2019	98	2.2±10.9	0.0	-2.998	0.003
		2020	120	1.6±2.5	0.0	-2.998	0.003
	Time duration to start first oncological treatment	2019	77	57.7±65.1	35.0	-1.166	0.243
	Time duration to start first oncological treatment	2020	105	73.2±82.6	42.0	-1.166	0.243

KFAFH: King Fahad Armed Forces Hospital, KSAFH: King Salman Armed Forces Hospital, PSMMC: Prince Sultan Military Medical City, AL HADA: Al Hada Armed Forces Hospital, AFHSR: Armed Forces Hospital Southern Region, SD: standard deviation, KPI: key performance indicator

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Table 4

- Comparison between the 2 samples (2019 and 2020) in terms of referral activities among different hospitals.

Hospitals	Year	Referral status				Eligibility status
Hospitals	Year	Same hospital	Other military	Other civilian	P-value	Military	Non military	P-value
KFAFH Jeddah	2019	191	3	6	0.23	192	2	0.86
KFAFH Jeddah	2020	108	3	8	0.23	119	1	0.86
KSAFH Tabuk	2019	89	2	6	0.00	101	9	0.00
KSAFH Tabuk	2020	91	6	35	0.00	113	30	0.00
PSMMC Riyadh	2019	286	55	15	0.01	345	20	0.15
PSMMC Riyadh	2020	183	26	24	0.01	228	7	0.15
AFHSR Khamis Mushait	2019	75	1	6	0.45	77	3	0.89
AFHSR Khamis Mushait	2020	92	0	5	0.45	93	4	0.89
AL HADA Taif	2019	64	6	29	0.09	72	27	0.56
AL HADA Taif	2020	60	11	49	0.09	83	37	0.56

Total of the variables are not equal to the total sample size due to some “missing data” in these variables. KFAFH: King Fahad Armed Forces Hospital, KSAFH: King Salman Armed Forces Hospital, PSMMC: Prince Sultan Military Medical City, AL HADA: Al Hada Armed Forces Hospital, AFHSR: Armed Forces Hospital Southern Region

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Table 5

- Characteristics of COVID positive patients.

Characteristics	n	%
Number of cases by hospital
KFAFH Jeddah	11	14.5
KSAFH Tabuk	12	15.8
PSMMC Riyadh	38	50.0
AFHSR Khamis Mushait	2	2.6
AL HADA Taif	13	17.1
Gender
Male	28	36.8
Female	48	63.2
Symptomatic
Yes	55	71.6
No	21	28.4
*^Common symptoms**
Fever	31	58.5
Cough	26	49.1
Shortness of breath	14	26.4
Diarrhea	5	9.4
Outcome of Covid-19
Active	1	1.3
Recovered	55	72.4
Hospitalized (in ICU on ventilator)	3	3.9
Expired due to Covid-19	17	22.4
Cancer outcome
Stable	23	30.3
Response to treatment	21	27.6
Progression	7	9.2
Treatment discontinued	1	1.3
Overall expired cases	23	30.3

↵* Common symptoms are not mutually exclusive. Total of the some variables are not equal to the total sample size due to some “missing data” in these variables. KFAFH: King Fahad Armed Forces Hospital, KSAFH: King Salman Armed Forces Hospital, PSMMC: Prince Sultan Military Medical City, AL HADA: Al Hada Armed Forces Hospital, AFHSR: Armed Forces Hospital Southern Region, ICU: intensive care unit