Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays

Changes in female cancer diagnostic billing rates over the COVID-19 period in the Ontario Health Insurance Plan

Background

The initial response to coronavirus disease 2019 (COVID-19) in Ontario included suspension of cancer screening programs and deferral of diagnostic procedures and many treatments. Although the short-term impact of these measures on female cancers is well documented, few studies have assessed the mid- to long-term impacts.

Objectives

To compare annual billing prevalence and incidence rates of female cancers during the COVID-19 period (2020-2022) to pre-COVID-19 levels (2015-2019).

Design

Retrospective analysis of aggregated claims data for female cancer diagnostic codes from the Ontario Health Insurance Plan (OHIP).

Methods

Linear regression analysis was used to fit pre-COVID-19 (2015-2019) data for each OHIP billing code and extrapolate counterfactual values for the years of 2020-2022. Excess billing rates were calculated as the difference between projected and actual rates for each year.

Results

In 2020, OHIP billing prevalence rates for cervical, breast, uterine, and ovarian cancers decreased relative to projected values for that year by -50.7/100k, -13.9/100k, -3.5/100k, and -3.8/100k, respectively. The reverse was observed in 2021 with rate increases of 47.8/100k, 59.1/100k, 2.5/100k, and 3.7/100k, respectively. In 2022, the excesses were further amplified, especially for cervical and breast cancers (111.2/100k and 78.67/100k, respectively). The net excess patient billing rate for 2020-2022 was largely positive for all female cancer types (108.3/100k, 123.7/100k, 5.2/100k, and 1.8/100k, respectively). Analysis of billing incidence rates showed similar trends.

Conclusion

The expected female cancer billing rate decreases in 2020 were followed by large increases in 2021 and 2022, resulting in a cumulative excess during the COVID-19 period. Further research is required to assess the nature of these changes.

Anxiety and depression in cancer patients and survivors in the context of restrictions in contact and oncological care during the COVID-19 pandemic

Treatment modifications and contact restrictions were common during the COVID-19 pandemic and can be stressors for mental health. There is a lack of studies assessing pandemic-related risk factors for anxiety and depression of cancer patients and survivors systematically in multifactorial models. A total of 2391 participants, mean age 65.5 years, ≤5 years post-diagnosis of either lung, prostate, breast, colorectal cancer, or leukemia/lymphoma, were recruited in 2021 via the Baden-Württemberg Cancer Registry, Germany. Sociodemographic information, pandemic-related treatment modifications, contact restrictions, and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were assessed via self-administered questionnaire. Clinical information (diagnosis, stage, and treatment information) was obtained from the cancer registry. Overall, 22% of participants reported oncological care modifications due to COVID-19, mostly in follow-up care and rehabilitation. Modifications of active cancer treatment were reported by 5.8%. Among those, 50.5% had subclinical anxiety and 55.4% subclinical depression (vs. 37.4% and 45.4%, respectively, for unchanged active treatment). Age <60 years, female sex, lung cancer, low income, and contact restrictions to peer support groups or physicians were identified as independent risk factors for anxiety. Risk factors for depression were lung cancer (both sexes), leukemia/lymphoma (females), recurrence or palliative treatment, living alone, low income, and contact restrictions to relatives, physicians, or caregivers. The study demonstrates that changes in active cancer treatment and contact restrictions are associated with impaired mental well-being. The psychological consequences of treatment changes and the importance for cancer patients to maintain regular contact with their physicians should be considered in future responses to threats to public health.

Evaluation of mental disorder related to colposcopy procedure during the COVID period: A cross-sectional study

BACKGROUND

The Coronavirus Disease (COVID-19) has had a significant impact on healthcare organizations, leading to a reduction in screening. The pandemic period has caused important psychological repercussions in the most fragile patients.

OBJECTIVES

This study aimed to assess the levels of depression, anxiety, peri-traumatic stress, and physical symptoms in patients undergoing colposcopy during the COVID-19 pandemic and to compare these data with the post-pandemic period.

DESIGN

This longitudinal study included 96 individuals undergoing colposcopy, aged between 22 and 64, who were examined between March 2020 and December 2023.

METHODS

Participants were assessed at four distinct time points, referred to as T0, T1, T2, and T3. T0 encompassed the pandemic period, ranging from March 2020 to August 2020, while T1 occurred 1 year later, T2 and T3 correspond to data collected in 2022 and 2023. Statistical analysis was conducted to assess the impact of the COVID-19 pandemic on various psychological variables. Descriptive statistics, including means, standard deviations, and frequency distributions, were calculated for each psychological variable within each time period.

RESULTS

Our findings revealed a significant reduction in peri-traumatic stress and pain levels in the post-pandemic (from 2021 to 2023) period compared to the pandemic period. Conversely, anxiety and depression levels exhibited a statistically significant increase in the post-pandemic period and then gradually decrease in the subsequent follow-up.

CONCLUSION

This study provides valuable insights into the profound impact of the COVID-19 pandemic on psychological distress experienced during the pandemic period itself, as well as its enduring effects on anxiety and depression in the subsequent period.

Advanced practice radiation therapist led vaginal vault brachytherapy: An evaluation of efficiency and effectiveness of service delivery

Aims

An advanced practice radiation therapist (APRT) role in vaginal vault brachytherapy (VBT) was first introduced in 2015. The aim of this manuscript was to clarify how the introduction of an APRT can improve efficiencies within service delivery while maintaining non inferior clinical outcomes of recurrence.

Materials and methods

This was a single-centred retrospective comparative service evaluation of stage 1 endometrial cancer patients treated with postoperative high dose rate VBT alone. Sixty patients in total were included in the evaluation. They were divided into two equal groups of 'before' and 'after' based on the introduction of the APRT-led role and changes made to treatment processes. Quantitative analysis of waiting times from surgery to adjuvant VBT (weeks), duration of day one treatment procedure (minutes), rate of isolated vaginal recurrence and loco regional recurrence (vaginal and pelvic) were compared between the groups.

Results

The mean time from surgery to treatment between the 'before' and 'after' groups was 13.1 and 9.1 weeks respectively. The mean time for day one treatment procedure was 91 min in the 'before' group and 59 min in the 'after' group. Vaginal free recurrence (VFR) was 100 % for both groups..

Conclusion

An APRT led vaginal vault service, with learnt role extension, allows for a more efficient and effective service delivery.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology

PURPOSE

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization.

DESIGN/METHODOLOGY/APPROACH

From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization.

FINDINGS

On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR] = 3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR] = 4.05, 95% CI: 1.72-9.11).

RESEARCH LIMITATIONS/IMPLICATIONS

While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious.

PRACTICAL IMPLICATIONS

Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed.

SOCIAL IMPLICATIONS

Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable.

ORIGINALITY/VALUE

Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

The Impact of the COVID-19 Pandemic on Mental Health and Cognitive Function in Patients With Cancer: A Systematic Literature Review

BACKGROUND

The COVID-19 pandeminc has had widespread impacts, but its specific effects on mental health and cognitive function in patients with cancer remain under-explored.

RECENT FINDINGS

Data from the general population has suggested that mental health problems were frequent during the pandemic, namely during the initial stage of the outbreak. For patients with cancer, a systematic review and meta-analysis of data published until January 2021 also showed elevated prevalence of depression and anxiety, and suggested that anxiety was more frequent than in health workers and healthy controls.

OBJECTIVE

This systematic review aimed to synthesize existing evidence on the impact of the COVID-19 pandemic on mental health and cognitive function in patients with cancer.

METHODS

Studies were identified through systematic search of three electronic bibliographic databases (PubMed, Web of Science, and EBSCOHOST) with adapted search strings. We included only peer-reviewed, nonqualitative, original research papers, published between 2019 and 2022, and reporting on mental health and/or cognition outcomes during the COVID-19 pandemic in adult patients with cancer.

RESULTS

Of 3260 papers identified, 121 full text articles were retrieved and 71 met inclusion criteria. We found that patients with cancer reported high levels of psychological distress, anxiety and depression, as well as cognitive complaints during the pandemic. However, studies were not consistent in identifying these symptoms as effects of the pandemic specific for this population. In fact, longitudinal studies did not find consistent differences between pre- and post-pandemic periods and, globally, patients with cancer did not report increased severity of these mental health symptoms in relation to the general population.

CONCLUSION

Overall, while the COVID-19 pandemic may have raised mental health challenges for patients with cancer, the diagnosis of cancer and associated treatments seemed to remain the main source of concern for these patients.

Depression weights in patients with gastric cancer: Bibliometric analysis as a weapon to chart the future of research

Bibliometric analyses are increasing in the field of gastric cancer. This letter discusses a recently published analysis that focused on the bidirectional relationship between depression and gastric cancer and evaluated the types of papers published in this field and the changes in the direction of research. There is an increasing need for new, clinically relevant studies of this association.

Prevalence and risk factors for anxiety in patients with early- and middle-stage lung cancer: a cross-sectional study

Objective

Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide, with patients frequently experiencing significant psychological distress, particularly anxiety. Despite the high prevalence of anxiety in patients with cancer, there is limited comprehensive research focusing on the specific factors influencing anxiety in patients with early- and middle-stage lung cancer within the context of Chinese medicine hospitals. Therefore, we aimed to investigate the epidemiology and factors influencing anxiety disorders in patients with early- and middle-stage primary bronchial lung cancer through a cross-sectional study.

Methods

A total of 340 patients with early and middle-stage lung cancer admitted to the outpatient ward of the oncology department at Guang'anmen Hospital from June 2023 to December 2023 were included in this study. Survey data, including the patients' general condition questionnaire, Generalized Anxiety Scale (GAD-7), Hospital Anxiety and Depression Scale (HADS), and Mental Toughness Scale (CD-RISC-10), were collected and recorded in a database using a two-person input format. Data analysis was performed using SPSS 27.0 software.

Results

Out of the 340 patients with early- and middle-stage lung cancer included in this study, 133 had anxiety, resulting in an overall anxiety detection rate of 39.12%. The chi-square test showed that statistically significant differences in religion, marital status, surgical treatment, tobacco use, and alcohol history between the anxious and non-anxious groups (p < 0.05). Moreover, statistically significant differences were observed in per capita annual family income, pathological type, VAS score, targeted therapy, treatment stage, and mental toughness level (p < 0.001). Other factors were not significantly correlated with anxiety onset. Multivariate logistic regression analysis showed that higher per capita family income and completed treatment independently acted as protective factors against anxiety onset in patients with early- and middle-stage lung cancer. Conversely, rare pathological types, increased pain severity, and lower levels of mental toughness were identified as independent risk factors for anxiety onset in these patients.

Conclusion

Anxiety was prevalent in patients with early- and middle-stage lung cancers. Rare pathological types, increased pain severity, and lower levels of mental toughness were independent risk factors for anxiety. Therefore, clinicians and psychologists should pay more attention to patients with rare types of tumors, actively manage their pain symptoms, and consider implementing mental resilience training to improve patients' mental toughness.

Patients' preferences, experiences and expectations with wait time until surgery in gynaecological oncology: a mixed-methods study in two gynaecological oncological centres in the Netherlands

OBJECTIVES

Patient-centredness of care during wait time before surgery can be improved. In this study we aimed to assess (1) patients' experiences with and preferences regarding wait time before surgery; (2) the impact of wait time on quality of life (QoL) and (3) which factors influence patients' wait time experience.

DESIGN, SETTING, PARTICIPANTS

We performed an exploratory sequential mixed-methods study among women with gynaecological cancer in two tertiary hospitals. We conducted semistructured interviews and identified aspects of QoL and factors that influenced wait time acceptability through thematic analysis. We developed a questionnaire from this thematic analysis which was completed by 97 women. Descriptive statistics and univariate and multivariate regression analyses were performed.

RESULTS

Average ideal wait time was 3.5 weeks (±1.7 weeks), minimum and maximum acceptable wait times were 2.2 and 5.6 weeks. Many patients scored above the threshold of the Hospital Anxiety and Depression Scale for anxiety (48%) or depression (34%), had sleeping problems (56%) or experienced pain (54%). A number of factors were more common in patients who indicated that their wait time had been too long: low education level (OR 7.4, 95% CI 0.5 to 5.0, p=0.007), time to surgery >4 weeks (OR 7.0, 95% CI 0.8 to 4.4, p=0.002) and experienced sleep disturbance (OR 3.27, 95% CI 0.0 to 3.1, p=0.05). If patients expectation of wait time was >4 weeks (OR 0.20, 95% CI -4.0 to -0.5 p=0008) or if patients experienced pain (OR 0.26, 95% CI -3.6 to -0.3, p=0.03), they less frequently indicated that wait time had been too long.

CONCLUSION

To improve patient-centredness of care, healthcare providers should aim to reduce wait time to 3-4 weeks and ensure that patients are well informed about the length of wait time and are aware of high levels of anxiety, depression and pain during this time. Future studies should evaluate what interventions can improve QoL during wait time.

A narrative systematic review of changes in mental health symptoms from before to during the COVID-19 pandemic

The onset of the COVID-19 pandemic raised concerns regarding population-wide impacts on mental health. Existing work on the psychological impacts of disaster has identified the potential for multiple response trajectories, with resilience as likely as the development of chronic psychopathology. Early reviews of mental health during the pandemic suggested elevated prevalence rates of multiple forms of psychopathology, but were limited by largely cross-sectional approaches. We conducted a systematic review of studies that prospectively assessed pre- to peri-pandemic changes in symptoms of psychopathology to investigate potential mental health changes associated with the onset of the pandemic (PROSPERO #CRD42021255042). A total of 97 studies were included, covering symptom clusters including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fear, anxiety, depression, and general distress. Changes in psychopathology symptoms varied by symptom dimension and sample characteristics. OCD, anxiety, depression, and general distress symptoms tended to increase from pre- to peri-pandemic. An increase in fear was limited to medically vulnerable participants, and findings for PTSD were mixed. Pre-existing mental health diagnoses unexpectedly were not associated with symptom exacerbation, except in the case of OCD. Young people generally showed the most marked symptom increases, although this pattern was reversed in some samples. Women in middle adulthood in particular demonstrated a considerable increase in anxiety and depression. We conclude that mental health responding during the pandemic varied as a function of both symptom cluster and sample characteristics. Variability in responding should therefore be a key consideration guiding future research and intervention.

Effect of a Same-Day-Appointment Initiative on Access-Related Benchmarks in Radiation Oncology

PURPOSE

The timely delivery of health care is an important quality indicator that has been shown to correlate with outcomes for cancer patients. We present our single-institution experience with the implementation of a same-day-access scheduling initiative in outpatient radiation oncology.

METHODS AND MATERIALS

From March 2021 to March 2023, a total of 4301 consecutive new patients referred for radiation oncology consultation were offered same-day appointments as part of a prospective pilot initiative conducted at a tertiary-based academic medical center. Descriptive statistics were used to study the effect of this initiative on access-related benchmarks compared with historical control patients referred during a preceding 24-month period.

RESULTS

Among the 3414 patients scheduled, 477 (14%) opted for same-day appointments. Black, Latino, and Asian patients were significantly more likely to use same-day access versus Caucasian patients (P < .001). The same-day-access initiative increased the proportion of patients seen within 5 days from referral from 22% to 61% (P < .001). The median time from referral to consult was 12 days (range, 0-149 days) before the implementation of the same-day-access initiative compared with 3 days (range, 0-101 days) after (P < .001). The no-show rate was reduced from 15% to 7% with the initiative (P < .001). All patients who requested a same-day appointment were successfully accommodated.

CONCLUSIONS

The implementation of this same-day-access initiative enhanced operational efficiency and reduced barriers to care in the outpatient setting.

Symptom clusters associated with complementary and alternative medicine use by cancer patients: A cross-sectional study

BACKGROUND

Complementary and alternative medicine (CAM) is a commonly used approach among cancer patients, with a reported prevalence of 14.8 to 73.1% depending on multiple factors. Even though a typical patient-reported reason for using CAM is symptom control, no conclusive evidence could be established for specific symptoms being a predictor for CAM use. Symptom clusters are a novel approach for assessing a multidimensional symptom burden, reflecting the impact of diseases on the patient's quality of life and considering the tendency of symptoms to occur in groups.

MATERIAL AND METHODS

A single-center cross-sectional study on cancer patients during oncological or palliative care was conducted to identify socio-demographical and clinical characteristics, including symptom clusters of CAM users and non-users. Symptom clusters were defined using latent profile analysis, and multivariable analyses were performed to assess significant factors influencing CAM use.

RESULTS

Of 171 cancer patients in this study, 63.7% used CAM alongside oncological treatment or palliative care. The most common CAM therapies were biological and physical therapies, including homeopathy (30.3%), supplements (27.4%), herbs (26.6%), massage (24.8%), and acupuncture (22.0%). Four distinct symptom clusters were identified, of which the cluster drowsiness-depression-anxiety was associated with a 3.83-fold increased chance of using CAM compared to low-symptomatic cancer patients. Multivariate analysis did not show any additional significant predictors of socio-demographical factors.

CONCLUSION

Using the concept of symptom clusters revealed a significant predictor for CAM use, suggesting to be a more conclusive method for assessing symptom burden in cancer patients. In addition, understanding why and how cancer patients turn to CAM can enhance the quality of multidisciplinary communication about its use.

Relationship between lifestyle changes due to the COVID-19 pandemic and depression: Nationwide population-based research using Community Health Survey data in South Korea

AIMS

This study evaluated the association between depression and lifestyle changes due to the COVID-19 pandemic and evaluated this association in patients with chronic diseases.

METHODS

Data were obtained from the 2020 Community Health Survey in South Korea. This study included 212,806 participants and perceived changes in life patterns (sleep, food, and exercise) after the COVID-19 outbreak were measured. People with hypertension or diabetes were categorized as patients with chronic diseases and depression was defined as a score of ≥10 on the Patient Health Questionnaire-9.

RESULTS

Compared with before the COVID-19 pandemic, increased or decreased sleep, the consumption of instant food, and decreased physical activity were associated with increased depression. Compared with the general population, patients with chronic diseases showed increased depression, with or without medication. Additionally, among patients with chronic diseases not taking medication, increased physical activity was associated with reduced depression, whereas reduced physical activity was associated with increased depression in both younger and older groups.

CONCLUSIONS

This study found that unhealthy lifestyle changes during the COVID-19 pandemic were associated with increased depression. Maintaining a certain lifestyle is important for mental health. Chronic disease patients need appropriate disease management, including physical activity.

"I Have Constant Fear": A National Qualitative Study on the Impact of COVID-19 on Cancer Care and Potential Solutions to Improve the Cancer Care Experience During the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has greatly affected cancer care delivery for patients, including cancellation or delays in surveillance imaging, clinic visits, and treatments. Yet, gaps remain in understanding the extent of the impact of the COVID-19 pandemic on patients with cancer and potential ways to overcome these impacts.

METHODS

We conducted semistructured, in-depth, one-on-one qualitative interviews among adults with a past or current history of cancer in the United States. Participants from a parent quantitative survey were purposively sampled to participate in a qualitative interview. Interview questions addressed (1) experiences with cancer care delivery during the COVID-19 pandemic; (2) unmet concerns regarding care and other impacts; and (3) approaches to improve patient experiences. We conducted inductive thematic analysis.

RESULTS

Fifty-seven interviews were conducted. Four themes emerged: (1) concern regarding the risk of COVID-19 infection among patients with cancer and their families; (2) disruptions in care increased patients' anxiety about poor cancer outcomes and death from cancer; (3) significant social and economic impacts; and (4) increased social isolation and anxiety about the future. Suggestions for current clinical practice include (1) clear communication on patients' health risks; (2) increased attention to mental health needs and access to mental health services; and (3) routine use of telemedicine as frequently as possible when clinically appropriate.

CONCLUSION

These rich findings reveal the significant impact of the COVID-19 pandemic on patients with cancer and potential approaches to mitigate the impact from the patient perspective. The findings not only inform current cancer care delivery but also health system responses to future public health or environmental crises that may pose a unique health risk for patients with cancer or disrupt their care.

Impact of the COVID-19 pandemic on cancer patients in western Pennsylvania: rural-urban disparities

PURPOSE

Disparities in cancer care persist between patients living in rural versus urban areas. The COVID-19 pandemic may have impacted concerns related to care and personal health differently in rural cancer patients. Using survey data collected from cancer patients in western Pennsylvania, we examined pandemic-related distress, concerns related to cancer care, impact on personal health, and the extent to which these differed by urban-rural residence.

METHODS

Patients filled out an initial survey in August-December 2020; a second survey was completed in March 2021. The following patient concerns related to the pandemic were evaluated: threat of COVID-19 to their health, pandemic-related distress, perceptions of cancer care, and vaccine hesitancy. Multivariable logistic regression models were used to examine relationships between these outcomes and urban-rural residence as well as patient-related factors, including anxiety symptoms and social support.

RESULTS

The study sample included 1,980 patients, 17% resided in rural areas. COVID-19 represented a major or catastrophic threat to personal health for 39.7% of rural and 49.0% of urban patients (p = 0.0017). Patients with high general anxiety were 10-times more likely to experience pandemic-related distress (p < 0.001). In the follow-up survey (n = 983), vaccine hesitancy was twice as prevalent among rural patients compared to urban (p = 0.012).

CONCLUSIONS

The extent to which perceptions of the threat of COVD-19 to personal health and vaccine hesitancy exacerbates rural-urban disparities in cancer care and prognosis warrants further study. Cancer patients may be vulnerable to heightened anxiety and distress triggered by the pandemic.

Young Adult German Breast Cancer Patients Participating in a Three-Week Inpatient Mother–Child Rehab Program Have High Needs for Supportive Care

A known cut-off problem hampers the interpretation of quality of life (QOL) scores. The purpose of this study was to apply a novel approach for the EORTC QLQ-C30 instrument to identify the proportion of breast cancer (BC) patients in need of supportive care. Changes in QOL during the COVID-19 pandemic were evaluated, as well as changes over time (after treatment termination and up to 4 years later). Data were obtained from a cohort study on young adult BC patients with minor children participating in a mother–child rehab program. Cross-sectional QOL data were collected from 2015 to 2021 (baseline). Follow-up data were available for up to 4 years after diagnosis for a subgroup. The baseline cohort included 853 women (mean age 35 years). More than 50% had a need for supportive care. In the subgroup with follow-up, this proportion remained at a high level up to several years after diagnosis. During the COVID-19 pandemic, changes regarding the proportion with this need were not as high as expected—with the exception of changes on the QLQ-C30 scale ‘role functioning’ (+15%). Even several years after diagnosis, every second BC patient with minor children had a need for supportive care, which is much higher than previously found. Healthcare staff should be aware of this potential need and should address this issue.

Psychological Well-Being of Cancer Patients before and during the Pandemic: The Impact of COVID-19 Peritraumatic Distress

BACKGROUND

This study aimed to evaluate the psychological impact of the COVID-19 pandemic on cancer patients.

METHODS

Ninety cancer patients undergoing chemotherapy with antiblastics were recruited from a tertiary medical center and completed a battery of standardized questionnaires to assess anxiety, depression, peritraumatic stress, and quality of life before and during the pandemic.

RESULTS

Quality of life worsened significantly during the pandemic compared with the pre-pandemic period. Anxiety and depression levels also increased significantly during the pandemic. COVID-19 peritraumatic distress significantly predicted lower quality-of-life scores during the pandemic.

CONCLUSIONS

COVID-19 distress affected the overall quality of life of patients who already had lower levels of quality of life before the pandemic and who had advanced cancers. Cancer patients must receive adequate support from psychiatrists and psychologists to mitigate the psychological distress related to the pandemic.

The Experience of COVID-19 in a Sample of Gynecological Cancer Patients Undergoing Chemotherapy: A Focus on the Psychological Implications

Cancer patients are at an increased risk of developing severe consequences due to the COVID-19 infection. However, psychological outcomes in this population have been overlooked in the literature. The present study aims to identify significant psychological differences between gynecological cancer patients undergoing chemotherapy before and during the pandemic. Additionally, we explore the correlations between COVID-19-related concerns and anxiety, depression, distress, and quality of life levels. Forty-two patients completed the STAI-Y, the EORTC QLQ-C30, the BDI II, the DT, and an ad-hoc questionnaire that investigated COVID-19-related concerns. The analyses did not show significant differences in the psychometric scales between the two groups, highlighting a considerable resilience against mental health and quality of life deterioration during the COVID-19 pandemic in gynecologic cancer patients. However, COVID-19-related concerns were positively associated with anxiety and inversely related to emotional functioning levels. These results emphasize the importance of a comprehensive patient care and the need to implement a multidisciplinary approach that includes psychological support in the treatment plan. Moreover, it is essential to encourage clear communication to convey comprehensive information about the impact of the pandemic on physical and psychological levels, as well as to offer psychoeducational tools to face the pandemic.

Care patterns and Traditional Chinese Medicine constitution as factors of depression and anxiety in patients with systemic sclerosis: A cross-sectional study during the COVID-19 pandemic

Objective

Care patterns and Traditional Chinese Medicine (TCM) constitution affects the emotion and health of patients with systemic sclerosis (SSc) while the prevalence of COVID-19 may aggravate such patients' emotion and health. We investigated the depression and anxiety levels of patients with SSc during the pandemic to identify the correlation between care patterns, TCM constitution, and patients' emotion.

Materials and methods

This was a cross-sectional study. Patients with SSc and healthy individuals were surveyed using the patient health questionnaire-9, generalized anxiety disorder-7, and constitution in Chinese medicine questionnaire and a modified care pattern questionnaire. Factors correlated with depression and anxiety were screened using univariate and multivariate logistic regression analyses.

Results

A total of 273 patients with SSc and 111 healthy individuals were included in the analysis. The proportion of patients with SSc who were depressed was 74.36%, who had anxiety was 51.65%, and who experienced disease progression during the pandemic was 36.99%. The proportion of income reduction in the online group (56.19%) was higher than that in the hospital group (33.33%) (P = 0.001). Qi-deficiency [adjusted odds ratio (OR) = 2.250] and Qi-stagnation (adjusted OR = 3.824) constitutions were significantly associated with depression. Remote work during the outbreak (adjusted OR = 1.920), decrease in income (adjusted OR = 3.556), and disease progression (P = 0.030) were associated with the occurrence of depression.

Conclusion

Chinese patients with SSc have a high prevalence of depression and anxiety. The COVID-19 pandemic has changed the care patterns of Chinese patients with SSc, and work, income, disease progression, and change of medications were correlates of depression or anxiety in patients with SSc. Qi-stagnation and Qi-deficiency constitutions were associated with depression, and Qi-stagnation constitution was associated with anxiety in patients with SSc.

Trial registration

http://www.chictr.org.cn/showproj.aspx?proj=62301, identifier ChiCTR2000038796.

Assessment of Cancer Patients' Mental Health during the Coronavirus Pandemic in Serbia

This study aimed to determine the impact of the COVID-19 pandemic on the mental health of cancer patients in Serbia. Data were collected between April-May 2021 using an online questionnaire, which estimated depression, anxiety, and stress in a sample of 221 cancer patients. The Depression, Anxiety, and Stress Assessment Scale (DASS-21) was used to assess the cancer patients' affective status. The T test of independent samples and the one-way analysis of variance (ANOVA), as well as multiple linear regression analysis, have been used as well. The results showed that moderate to extremely severe depression, anxiety, and stress symptoms were present in 33.9%, 21.2%, and 26.7% of patients, respectively. Older patients and those who assessed their socioeconomic and health status as better were less anxious, depressed, and stressed. The study shows that the patients who have stated that medical help has been available significantly differ from those patients who have not had available medical help, meaning that they have shown lower scores on the scales of depression and stress. When it comes to the availability of medical help during the pandemic, statistically significant differences among patients on the scale of anxiety have not been proven. It has been determined that statistically important differences exist between patients who have needed psychological help and those who have not needed it when it comes to the results on all of the three subscales. The patients who have expressed the need for psychological help have higher levels of depression, anxiety, and stress. The patients who have not had available psychological help have higher levels of depression, anxiety, and stress when compared to the patients who have had available psychological help.

Survival outcomes following treatment delays among patients with early-stage female cancers: a nationwide study

BACKGROUND

The coronavirus disease 2019 (COVID-19) severely hindered the timely receipt of health care for patients with cancer, especially female patients. Depression and anxiety were more pronounced in female patients than their male counterparts with cancer during treatment wait-time intervals. Herein, investigating the impact of treatment delays on the survival outcomes of female patients with early-stage cancers can enhance the rational and precise clinical decisions of physicians.

METHODS

We analyzed five types of cancers in women from the Surveillance, Epidemiology, and End Results (SEER) program between Jan 2010 and Dec 2015. Univariate and multivariate Cox regression analyses were used to determine the impacts of treatment delays on the overall survival (OS) and cancer-specific survival (CSS) of the patients.

RESULTS

A total of 241,661 females with early-stage cancer were analyzed (12,617 cases of non-small cell lung cancer (NSCLC), 166,051 cases of infiltrating breast cancer, 31,096 cases of differentiated thyroid cancer, 23,550 cases of colorectal cancer, and 8347 cases of cervical cancer). Worse OS rates were observed in patients with treatment delays ≥ 3 months in stage I NSCLC (adjustedHazard ratio (HR) = 1.11, 95% Confidence Interval (CI): 1.01-1.23, p = 0.044) and stage I infiltrating breast cancer (adjustedHR = 1.23, 95% CI 1.11-1.37, p < 0.001). When the treatment delay intervals were analyzed as continuous variables, similar results were observed in patients with stage I NSCLC (adjustedHR = 1.04, 95% CI 1.01-1.06, p = 0.010) and in those with stage I breast cancer (adjustedHR = 1.03, 95% CI 1.00-1.06, p = 0.029). However, treatment delays did not reduce the OS of patients with differentiated thyroid cancer, cervical cancer, or colorectal cancer in the early-stage. Only intermediate treatment delays impaired the CSS of patients with cervical cancer in stage I (adjustedHR = 1.31, 95% CI 1.02-1.68, p = 0.032).

CONCLUSION

After adjusting for confounders, the prolonged time from diagnosis to the initiation of treatment (< 6 months) showed limited negative effects on the survival of most of the patients with early-stage female cancers. Whether our findings serve as evidence supporting the treatment deferral decisions of clinicians for patients with different cancers in resource-limited situations needs further validation.

Factors contributing to delays in initiation of front-line cervical cancer therapy: disparities in a diverse south Florida population

OBJECTIVE

Delay in initiating cervical cancer treatment may impact outcomes. In a cohort of patients initially treated by surgery, chemoradiation, chemotherapy, or in a clinical trial, we aim to define factors contributing to prolonged time to treatment initiation.

METHODS

Data from patients initiating treatment for cervical cancer at a single institution was abstracted. Time to treatment initiation was defined as the interval from the date of cancer diagnosis to the date of treatment initiation. Poisson regression model was used for analysis.

RESULTS

Of 274 patients studied, the median time to treatment initiation was 60 days (range 0-551). The median times to initiate surgery (54 days, range 3-96) and chemoradiation (58 days, range 4-187) were not significantly different (relative risk (RR) 1.01, 95% CI 0.98 to 1.04, p=0.54). The shortest median initiation time was for chemotherapy (47 days; RR 1.13, 95% CI 1.08 to 1.19, p<0.0001) and the longest was for clinical trial (62 days; RR 1.18, 95% CI 1.12 to 1.24, p<0.0001). Charity care (RR 1.09, 95% CI 1.05 to 1.14, p<0.0001), Medicare or Medicaid (RR 1.10, 95% CI 1.06 to 1.14, p<0.0001), and self-pay (RR 1.38, 95% CI 1.32 to 1.45, p<0.0001) delayed treatment initiation more than private insurance. Hispanic White women (RR 0.69, 95% CI 0.66 to 0.73, p<0.0001) had a shorter treatment initiation time compared with non-Hispanic White patients, while Afro-Caribbean/Afro-Latina women (RR 0.86, 95% CI 0.81 to 0.90, p<0.0001) and African-American patients (RR 1.13, 95% CI 1.07 to 1.19, p<0.0001) had longer initiation times. Spanish speaking patients did not have a prolonged treatment initiation (RR 0.68, 95% CI 0.66 to 0.71, p<0.0001), though Haitian-Creole speaking patients did (RR 1.07, 95% CI 1.01 to 1.13, p<0.002). Diagnosis at an outside institution delayed treatment initiation time (RR 1.24, 95% CI 1.18 to 1.30, p<0.0001) compared with diagnosis at the cancer center.

CONCLUSION

Factors associated with prolonged time to treatment initiation include treatment modality, insurance status, language spoken, and institution of diagnosis. By closely examining each of these factors, barriers to treatment can be identified and modified to shorten treatment initiation time.

Burden of Hospital-acquired SARS-CoV-2 Infections in Germany

Background

Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany.

Aim

To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants.

Methods

Patients with SARS-CoV-2 infections hospitalized between March 1^st, 2020 and May 17^th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source.

Findings

In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19–0.24), 8.8% during Delta (2.70; 2.35–3.09) and 10.1% during Omicron (1.10; 1.03–1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740–0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69–0.88), ventilation (0.47; 0.39–0.56), and death (0.33; 0.28–0.40).

Conclusion

Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.

Substantial Impairment of Quality of Life during COVID-19 Pandemic in Patients with Advanced Rectal Cancer

The aim of this study was to analyze the quality of life of patients with advanced rectal cancer before and during the COVID-19 pandemic and to determine whether the pandemic affected patients’ quality of life. The study included 389 patients and was performed from May 2010 to June 2021. The fifteen months from March 2020 to June 2021 were categorized as the COVID-19 period. Patients were surveyed using the QLQ-C30 and QLQ-CR38 questionnaires. The questionnaires were used at different phases of radiochemotherapy: prior to RCT (day 1), during RCT (day 14), at the end of RCT (day 35), and prior to mesorectal surgery (day 70). Scores were formed from the questions. In addition, scores were analyzed for different age groups (<64 and >64) and sexes (female and male). Overall, patients reported lower functional scores and higher symptom scores during the pandemic than before the pandemic. Although it had been expected that older and younger patients would differ clearly, there were only minor differences. The comparison between the two sexes showed very different scores, with female patients having lower functional scores and higher symptom scores than male patients before and especially during COVID-19. In conclusion, age does not play a major role in quality of life, but sex does play an important role in perception of functioning and symptoms. COVID-19 also had a major impact on patients’ lives, as it was a very isolating and stressful time for everyone, especially cancer patients, which was reflected in worsening scores.

The psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review

BACKGROUND

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Global social lockdowns were instigated to reduce spread and prevent health-services from becoming overwhelmed. People having treatment for cancer are known to have heightened psychological/emotional burden. The combined impact of managing pandemic regulations alongside this may present additional burden. The purpose of this systematic review is to examine current evidence of the psychological and emotional impact of COVID-19 on people with cancer, early in the pandemic.

METHODS

Five electronic databases were searched (Embase, Global Health, HMIC, PsychINFO, CINAHL) from September 2019 to October 2021. Qualitative, quantitative and mixed-method primary research studies exploring emotional and psychological impacts of COVID-19 on cancer patients, limited to English language, were included. Quality appraisal was conducted using the MMAT.

RESULTS

Fifty-one papers, with 27,356 people from 21 countries treated for cancer, were included. 43 studies were quantitative with a survey method approach, six studies qualitative and four used a mixed methods design. MMAT score was mostly two or three. Four themes were identified: Emotional aspects and Quality of Life; Psychosocial aspects; Impact of COVID-19 on self; Impact of COVID-19 on cancer, with themes overlapping.

CONCLUSION

Whilst emotional/psychological impacts such as anxiety, isolation, employment fears, and uncertainty about the future were potentially universal concerns early in the pandemic, they may have been particularly acute for people living with cancer and represent complex, overlapping factors. As COVID-19 continues to impact health-services and society, it is important to focus on any ongoing impact to the experience of cancer patients. Most of the studies reviewed used tools that do not provide deeper understanding of how and why emotional states of people with cancer were affected. Further qualitative work may reveal patterns of what was unique to cancer patients during the pandemic, compared to general populations.

The Association of Socioeconomic Status, the Concern for Catching Covid-19, and Anxiety Between Individuals with and without a Cancer History from a Cross-sectional Study

Background

COVID-19 has negative impacts on mental health in all populations. Individuals with a history of cancer have an increased risk of catching and having more severe symptoms of COVID-19 than the general public. The objective of this study was to examine how cancer history and concern for catching COVID-19 relate to anxiety.

Methods

This cross-sectional study is part of the "Impact of COVID-19 on Behaviors across the Cancer Control Continuum in Ohio" project conducted from June to November 2020. The sample consisted of 7012 participants who completed survey online, by phone, or by mail. Self-reported concern for catching COVID-19 and anxiety over the last 7 days were used. Linear and logistic regression models were performed to determine the association between demographics, cancer history, concern for catching COVID-19, and anxiety.

Results

In our study sample, most participants rated their concern for catching COVID-19 as moderately high or high (56%) and reported anxiety for one day or more (63%). Individuals with a cancer history were more likely to report moderate-high or high concern for catching COVID-19 (59% vs.54%, P<0.001) but less likely to report anxiety (58% vs. 67%, P<0.001) compared to those without a cancer history. Individuals with higher SES were less likely to report anxiety (middle vs. low SES: OR=0.68, 95%CI=0.59-0.79; high vs. low SES: OR=0.70, 95%CI=0.61-0.82). Additionally, increased concern for catching COVID-19 was associated with higher likelihood of reporting anxiety (moderate-low vs. low: OR=1.65, 95%CI=1.42-1.92; moderate-high vs. low: OR=2.98, 95%CI=2.53-3.50; high vs. low: OR=4.35, 95%CI=3.74-5.07).

Conclusions

Our findings suggest individuals with a cancer history reported higher concern for catching COVID-19. Higher concern for catching COVID was associated with anxiety. These findings indicate that healthcare providers should pay special attention to the different populations to reduce concerns for catching COVID-19 and provide strategies to improve mental health during a pandemic outbreak.

Funding

This study was supported by a supplement to The Ohio State University Comprehensive Cancer Center (OSUCCC) core support grant ( P30 CA016058), and the OSUCCC The Recruitment, Intervention and Survey Shared Resource (RISSR)(P30 CA016058).The Ohio State University Center for Clinical and Translational Science grant support (National Center for Advancing Translational Sciences, Grant UL1TR001070) in publications relating to this project. This work was supported by the National Cancer Institute (F99CA253745 to X.Z.).

Has the COVID-19 pandemic affected the psychological state of arab cancer patients?

The Covid-19 pandemic has increased the vulnerability of cancer patients to psychological symptoms, in addition to treatment modality issues. The present study has aimed to determine the psychological state of Arab cancer patients during the COVID-19 pandemic and to explore the contributing factors. A cross-sectional, descriptive, correlational design with the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Functional Assessment of Cancer Therapy-Fatigue subscale (FACT-F), and the Functional Assessment of Cancer Therapy-General (FACT-G) were used to collect the data. Out of 291 participants, 60.5% were female; 22.7% were 51-60 years; 31.6% were diagnosed with breast cancer; 44.3% with stage 2 cancer; 23% had contracted COVID-19; and 43.3% had received their first dose of the vaccine. The main study findings are: 74.9% had anxiety, 64.3% experienced depression, 68% suffered from insomnia, and 69.8% had fatigue. Quality of life (QoL) was low among cancer patients who had marked anxiety, depression, insomnia, or fatigue, and these findings were statistically significant (p < 0.05). Predictive factors showed males were 5.09 times more likely to report depression; gynecological cancer patients were 40.4 times more likely to experience insomnia, and patients who had COVID-19 were 5.13 times more likely to report fatigue. The study findings reveal that the COVID-19 pandemic affected the psychological state of cancer patients and had a significant effect on their quality of life. Hence, there is a need to develop a holistic cancer health care approach, which is often limited in Arab countries, to help patients manage these symptoms effectively and to decrease the prevalence of mental health morbidity.

Breast cancer survivors’ physical activity and experiences while transitioning to a virtual cardiovascular rehabilitation program during a pandemic (COVID-19)

Breast cancer accounts for 25% of all cancers among Canadian females. Despite successes of decreased mortality, adverse treatment effects, such as cardiotoxicity, contribute to a sedentary lifestyle and decreased quality of life. Physical activity (PA) is a possible therapy for the late effects; however, COVID-19 restricted access to in-person cardiovascular rehabilitation (CR) programs. The purposes are as follows: (1) compare PA of breast cancer survivors’ in-person CR to virtual CR following a transition during COVID-19 and (2) compare the PA of the pandemic cohort to a matched cohort who had completed the program in 2018/2019; (3) explore survivors’ experiences of transitioning to and engaging in virtual CR. Mixed methods included analysis of CR PA data from a pandemic cohort (n = 18) and a 2018/2019 cohort (n = 18) and semi-structured focus group interviews with the pandemic cohort (n = 9) in the context of the PRECEDE-PROCEED model. After the transition, there were no significant differences in mean activity duration, frequency, and cumulative activity (expressed as MET-minutes) (p > 0.05). However, variation of PA duration doubled following the transition from in-person to virtual (p = 0.029), while for the 2018/2019 cohort, variation remained unchanged. Focus groups revealed that women valued their CR experiences pre-COVID-19 and had feelings of anxiety during the transition. Perceived factors affecting participation were environmental, personal, and behavioural. Recommendations for virtual programs were to increase comradery, technology, and professional guidance. PA experiences during a transition to virtual care prompted by a pandemic vary among breast cancer survivors. Targeting individualised strategies and exercise prescriptions are important for improving PA programs and patient outcomes.

Cancer and Covid-19: a preliminary study on the trauma aspects of Coronavirus in cancer patients

Objective

Because of Covid 19, it has become necessary to revise the treatment of cancer patients (“how” and “when”). That has had important psychological repercussions. The purpose of this study is the evaluation of the impact of Covid19 in terms of Post‐Traumatic Stress Disorder and Depression and the potential association with coping strategies.

Methods

We conducted an exploratory study with 106 patients undergoing treatment, using following questionnaires: Screening Questionnaire for Disaster Mental Health and Mini‐Mental Adjustment to Cancer.

Results

Only 25.5% of our sample showed symptoms of posttraumatic stress disorder (PTSD) and 6.6% revealed a probable presence of depression. In addition, it came up a significant correlation between SQD_P and the coping styles “Hopelessness” (r = 0.41 p < 0.001) and “Anxious Preoccupation” (r = 0.45, p < 0.001).

A strong correlation also emerged between non‐Covid 19 patients and PTSD (r = 0.29, p = 0.002).

Conclusions

Our preliminary data did not reveal a prevalence of PTSD, but the persistence of the health emergency requires to focus future research on protective and risk factors related to PTSD and psychological distress in cancer patients, in order to reduce the mental health burden of Covid19.

Examining the effects of prior Acceptance and Commitment Therapy (ACT) treatment among anxious cancer survivors during the COVID-19 pandemic: Evidence from a randomized controlled trial

Introduction

The COVID-19 pandemic has presented population-wide novel stressors. Acceptance and Commitment Therapy (ACT) may be potent for coping with novel, unpredictable stressors, but it is unknown whether pre-pandemic ACT treatment conferred protective benefit during the COVID-19 pandemic.

Methods

Participants (N = 73) from a previous randomized controlled trial of ACT (seven 2-h group sessions) versus minimally-enhanced usual care (MEUC) for anxious cancer survivors completed measures of anxiety symptoms, fear of cancer recurrence, and emotional approach coping during the trial and again during the pandemic in May, June/July, and November 2020, an average of 2.71 years after completing ACT or MEUC. We estimated hierarchical linear models to test overall and conditional differences over the trial timepoints, in the interval between the trial and May 2020, and between the pandemic timepoints.

Results

Compared to MEUC, ACT led to greater improvement on the outcomes during the 8-month trial follow-up, consistent with the main trial findings. Across the entire sample, anxiety symptoms and emotional approach coping worsened from the final trial assessment timepoint to May 2020 (ps < .001). During this period, ACT participants worsened significantly more on emotional approach coping (p = .035) than MEUC participants. No significant condition differences emerged at later pandemic timepoints.

Conclusions

Treatment with ACT several years earlier did not provide protective benefit to anxious cancer survivors during the pandemic, relative to MEUC. ACT interventions may need to be targeted to pandemic-specific stressors, or booster sessions may be required for prior ACT treatment completers when faced with novel stressors.

Counting the social, psychological, and economic costs of COVID-19 for cancer patients

PURPOSE

Cancer patients were particularly vulnerable to the adverse impacts of the COVID-19 pandemic given their reliance on the healthcare system, and their weakened immune systems. This systematic review examines the social, psychological, and economic impacts of COVID-19 on cancer patients.

METHODS

The systematic search, conducted in March 2021, captures the experience of COVID-19 Wave I, when the most severe restrictions were in place globally, from a patient perspective.

RESULTS

The search yielded 56 studies reporting on the economic, social, and psychological impacts of COVID-19. The economic burden associated with cancer for patients during the pandemic included direct and indirect costs with both objective (i.e. financial burden) and subjective elements (financial distress). The pandemic exasperated existing psychological strain and associated adverse outcomes including worry and fear (of COVID-19 and cancer prognosis); distress, anxiety, and depression; social isolation and loneliness. National and institutional public health guidelines to reduce COVID-19 transmission resulted in suspended cancer screening programmes, delayed diagnoses, postponed or deferred treatments, and altered treatment. These altered patients' decision making and health-seeking behaviours.

CONCLUSION

COVID-19 compounded the economic, social, and psychological impacts of cancer on patients owing to health system adjustments and reduction in economic activity. Identification of the impact of COVID-19 on cancer patients from a psychological, social, and economic perspective following the pandemic can inform the design of timely and appropriate interventions and supports, to deal with the backlog in cancer care and enhance recovery.

The psychological health of patients diagnosed with cancer in Iraq during the COVID-19 pandemic: A single center study

OBJECTIVE

The objective of this study was to assess the psychological health status of patients diagnosed with cancer in Iraq during the COVID-19 pandemic. The study aim was to measure the prevalence of depression, anxiety, and stress among patients diagnosed with cancer. Secondary aims were to assess the association between depression, anxiety, and stress with sociodemographic characteristics, cancer-specific characteristics, patients' experience in healthcare visit, risk perception towards COVID-19, and health concern during the outbreak.

METHODS

A cross-sectional study was conducted between September 1, 2020 and December 1, 2020 at an Oncology clinic in Baghdad. Included in the study were two hundred patients diagnosed with cancer. Data collected included: demographic variables (age, gender, residential location, marital status, education, employment status), clinical characteristics and cancer-specific parameters (duration since cancer diagnosis, cancer type, treatment duration, clinic visits frequency), experience during the pandemic (skipping or postponing treatment or periodical tests, suffering from new body pain, fear of acquiring the infection, fear of health deterioration), as well as psychological health status (depression, anxiety, stress). Pain, risk perception towards COVID-19, and health concern were measured using categorical Likert scale with responses being no, sometimes, and often. The psychological health status was measured by the "Depression, Anxiety, and Stress Scale" (DASS-21). Cut-off scores of the DASS-21 greater than 9, 7, and 14 represent a positive screen of depression, anxiety, and stress, respectively.

RESULTS

The prevalence of patients who screened positive for depression was 22.0%, anxiety 22.0%, and stress 13.5%. The prevalence of depression, anxiety and stress were significantly more in those who had university or higher education (34.3%, p-value <0.0001; 32.3%, p-value <0.0001; 19.2%, p-value = 0.02 respectively). Those were four times more likely to have depression and two times more likely to have anxiety than participants who had school education (OR = 4.40 CI [1.98-9.77], p-value <0.0001; OR = 2.55 CI [1.15-5.65], p-value = 0.02, respectively). The prevalence of anxiety was significantly the highest in the age group 16-39 years (40.9%) compared to 22.3% in the age group 40-64 years and 10.3% in the group ≥65 years (p-value = 0.02). Patients ≥65 years of age were less likely to develop anxiety compared to younger patients (OR = 0.44 CI [0.22-0.89], p-value = 0.02). As for the patients' experience in healthcare visit, 66 patients (33.0%) skipped or postponed their treatment or tests due to the outbreak. Around (8%) sometimes suffered from new body pain. Those who sometimes suffered from new body pain had significantly more depression than patients who did not suffer new pain or often had new pain (50.0% vs. 15.0% vs. 28.1% respectively, p-value = 0.002). Those were two times more likely to be depressed (OR = 2.18 CI [1.29-3.68], p-value = 0.003). Around (50%) of the patients were often afraid that their health would deteriorate during the outbreak. Those were significantly more depressed (31.7%, p-value = 0.002), anxious (30.7%, p-value <0.0001) and stressed (21.8%, p-value = 0.002) than those who did not have fear of losing their health and were two times more likely to have anxiety and stress.

CONCLUSION

These findings, especially the association between developing new pain and depression, raised concerns regarding the psychological health in patients diagnosed with cancer during COVID-19 pandemic. It is crucial to implement psychological health screening for patients diagnosed with cancer during the pandemic to help prevent any psychological health problems. The DASS-21 could be used as a screening tool for distress in these patients.

Psychological Distress Among Cancer Patients During COVID-19 Pandemic in the World: A Systematic Review

Aim: Patients with malignancies, experience high rates of psychological distress. Fear of Corona-infection combined with the interruptions in some treatment programs might affect the psychological health of cancer patients. This review study was conducted to investigate the psychological distress among cancer patients during COVID-19 pandemic to offer system-adapted individual solutions.

Materials and methods: To identify the psychological distress of cancer patients, a comprehensive search was carried out in PubMed, Web of Science, and Scopus. English language and original articles were included in this study. Articles that addressed any psychological distress among cancer patients during COVID-19 pandemic were included.

Results: At first 1,410 articles, were included in the study. After removing duplicate articles and reviewing the title and abstract, 55 articles were selected for the review. The findings of this study revealed COVID-19 greatly affects psychological health of cancer patients. Fear of COVID-19, fear of disease progression, disruption of oncology services, cancer stage, and immunocompromised status were the most common causes of psychological distress in oncology patients which can influence patients' decisions about treatment.

Conclusion: The COVID-19 related anxiety is an expected reaction to the current situation. Although psychological distress affects many people, it can confuse cancer patients to the point that they refuse to continue treatment for the fear of infection and worsening of their condition. Since the end of this pandemic is unknown, this action can endanger the health and prognosis of this group of patients, so it seems that using psychological interventions and intensive counseling in the current situation is one of the main priorities for cancer patients.

Cancer Treatment During COVID-19: A Qualitative Analysis of Patient-Perceived Risks and Experiences with Virtual Care

During the COVID-19 pandemic, most cancer centers shifted from in-person to virtual cancer care to curb community spread and ensure care continuity. This qualitative descriptive study aimed to understand cancer patient-perceived risks related to COVID-19 and cancer treatment, as well as the patient-perceived and experienced value of virtual care. From June to August 2020, focus groups were conducted with patients under active management or observation for a diagnosed malignancy in Toronto, Canada. A thematic analysis of six focus groups found that most participants worried more about treatment delays than they did about COVID-19 infection. Despite some concern about COVID-19 exposure in the hospital, care delays contributed to increased anxiety among participants who already subscribed to strict safety measures in their everyday lives. Most participants accepted virtual care for some appointment types; however, preference for in-person care was found to sustain the humanistic and therapeutic aspects of cancer care that many participants valued. Nuances in the appropriateness and adequacy of virtual cancer care still need exploration. Preserving the humanistic aspects of care is of paramount importance.

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

BACKGROUND/AIM

The anticipation of radiotherapy can cause distress and sleep disorders, which may be aggravated by the COVID-19 pandemic. This study investigated sleep disorders in a large cohort of patients with breast cancer before and during the pandemic.

PATIENTS AND METHODS

Twenty-three characteristics were retrospectively analyzed for associations with pre-radiotherapy sleep disorders in 338 patients. Moreover, 163 patients presenting before and 175 patients presenting during the COVID-19 pandemic were compared for sleep disorders.

RESULTS

Sleep disorders were significantly associated with age ≤60 years (p=0.006); high distress score (p<0.0001); more emotional (p<0.0001), physical (p<0.0001) or practical (p<0.0001) problems; psycho-oncological need (p<0.0001); invasive cancer (p=0.003); chemotherapy (p<0.001); and hormonal therapy (p=0.006). Sleep disorders were similarly common in both groups (prior to vs. during the pandemic: 40% vs. 45%, p=0.38).

CONCLUSION

Although additional significant risk factors for sleep disorders were identified, the COVID-19 pandemic appeared to have no significant impact on sleep disorders in patients scheduled for irradiation of breast cancer.