Patients' Responses to the Sudden Interruption of Chemotherapy During the Outbreak of the Novel Coronavirus: A Cross-Sectional Study

Biopsychosocial Associates of Psychological Distress and Post-Traumatic Growth among Canadian Cancer Patients during the COVID-19 Pandemic

OBJECTIVE

Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables that were associated with psychological distress and PTG during the pandemic using a biopsychosocial framework.

METHOD

A cross-section survey was undertaken of patients receiving ongoing care at a regional cancer centre in Ontario, Canada, between February and December 2021. Self-reported questionnaires assessing sociodemographic information, social difficulties, psychological distress (depression, anxiety fear of recurrence, and emotional distress), PTG, illness perceptions, and behavioural responses to the pandemic were administered. Disease-related information was extracted from patient health records.

RESULTS

Prevalences of moderate to severe levels of depression, anxiety, fear of recurrence and emotional distress were reported by 26.0%, 21.2%, 44.2%, and 50.0% of the sample (N = 104), respectively. Approximately 43% of the sample reported experiencing high PTG, and these positive experiences were not associated with levels of distress. Social factors, including social difficulties, being female, lower education, and unemployment status were prominent associative factors of patient distress. Perceptions of the pandemic as threatening, adopting more health safety behaviours, and not being on active treatment also increased patient likelihood to experience severe psychological distress. Younger age and adopting more health safety behaviours increased the likelihood of experiencing high PTG. The discriminatory power of the predictive models was strong, with a C-statistic > 0.80.

CONCLUSIONS

Examining both the positive and negative psychological patient outcomes during the pandemic has highlighted the complex range of coping responses. Interventions that adopt a multi-pronged approach to screen and address social distress, as well as to leverage health safety behaviours, may improve the adjustments in the pandemic aftermath.

Imagining one's personal future in women undergoing treatment for breast cancer: an exploratory study

We assessed self-defining future projections (SDFPs) in women with breast cancer (BC) and their relationships with disease characteristics and quality of life. Forty women with BC in the course of treatment and 50 controls were asked to generate SDFPs and completed questionnaires for depression and anxiety symptoms and quality of life. There was no group difference regarding specificity, meaning making, probability of produced future events, and the experience of a sense of personal continuity within SDFPs. BC patients' SDFPs were less distant in the future and characterised by more narratives about life threatening events and fewer narratives about future achievements. Chemotherapy was related to narratives about life threatening events and BC. Patients undergoing breast reconstruction reported fewer life-threatening events related to their cancer. Lower quality of life was associated with lower narratives about relationships in patients. Women undergoing treatment for BC envision their future in a less optimistic way with more narratives about life threatening events and a reduced time perspective that varied according to the type of treatment. Self-continuity and ability to imagine future specific events were preserved in patients, which are important processes helping individuals to cope with life difficulties and find meaning and direction in life.

The impact of COVID-19 pandemic on diagnosis and management of gastrointestinal cancers

Gastrointestinal (GI) cancer is one of the leading causes of death that affect many patients around the world. The coronavirus disease 2019 (COVID-19) pandemic significantly impacted our healthcare system in large that diagnosis and management of GI cancer have suffered with a reduction in cancer screening. This review will describe the current practices of cancer screening during COVID-19 pandemic and summarize how each GI cancer (esophageal, gastric, colorectal, and hepatocellular cancers) has been affected by COVID-19. World widely there has been a decreasing trend in screening, diagnosis, and management of GI cancers during the COVID-19 pandemic. Many healthcare institutions are now observing the effect of this change and implementing practice variations to adapt to the pandemic.

Breast Cancer Management in the Era of Covid-19; Key Issues, Contemporary Strategies, and Future Implications

During the COVID-19 pandemic, several priority diseases were not getting sufficient attention. Whilst breast cancer is a fatal disease affecting millions worldwide, identification and management of these patients did not initially attract critical attention to minimize the impact of lockdown, post-lockdown, and other measures. Breast cancer patients' conditions may not remain stable without proper care, worsening their prognosis. Proper care includes the timely instigation of surgery, systemic therapy, and psychological support. This includes low-and middle-income countries where there are already concerns with available personnel and medicines to adequately identify and treat these patients. Consequently, there was a need to summarize the current scenario regarding managing breast cancer care during COVID-19 across all countries, including any guidelines developed. We systematically searched three scientific databases and found 76 eligible articles covering the medical strategies of high-income countries versus LMICs. Typically, diagnostic facilities in hospitals were affected at the beginning of the pandemic following the lockdown and other measures. This resulted in more advanced-stage cancers being detected at initial presentation across countries, negatively impacting patient outcomes. Other than increased telemedicine, instigating neo-adjuvant endocrine therapy more often, reducing non-essential visits, and increasing the application of neo-adjuvant chemotherapy to meet the challenges, encouragingly, there was no other significant difference among patients in high-income versus LMICs. Numerous guidelines regarding patient management evolved during the pandemic to address the challenges posed by lockdowns and other measures, which were subsequently adopted by various high-income countries and LMICs to improve patient care. The psychological impact of COVID-19 and associated lockdown measures, especially during the peak of COVID-19 waves, and the subsequent effect on the patient's mental health must also be considered in this high-priority group. We will continue to monitor the situation to provide direction in future pandemics.

The Impact of the COVID-19 Epidemic on Diagnosis, Treatment, Concerns, Problems, and Mental Health in Patients with Gastric Cancer

INTRODUCTION

COVID-19 epidemic has had different effects on many diseases, including gastric cancer. Due to COVID-19 epidemic the importance of knowing the effects of the epidemic in patients to deal with it, the present study aimed to investigate the effect of COVID-19 on the diagnosis, treatment, concerns, problems, and mental health of patients with gastric cancer.

METHODS

The present study was a systematic review by searching the PubMed, Scopus, and Web of Science databases with the keywords of COVID-19 and gastric cancer. The articles that addressed any aspect of COVID-19 epidemic on diagnosis, treatment, problems, and mental health in patients with gastric cancer were included; the data were qualitatively summarized and presented in related tables.

RESULTS

A total 22 articles were included. The effects of COVID-19 on gastric cancer were divided into four categories of the effects of COVID-19 on the diagnosis, treatment and follow-up, concerns, and problems and mental health of patients with gastric cancer. The COVID-19 epidemic has reduced the number of screenings, altered treatment, and delayed or discontinued treatment, which caused problems and concerns such as sleep disturbances and stress.

CONCLUSION

Considering the effects of COVID-19 epidemic on gastric cancer and on the other hand, the continuation of the epidemic in the society, it is necessary for the officials and experts of the health system to design and implement necessary interventions to minimize the negative effects of epidemic on patients with gastric cancer.

Evaluating the burden of the COVID-19 pandemic on patients with colorectal cancer

After the emergence of the coronavirus disease 2019 (COVID-19) pandemic, individuals needing medical help preferred to not go to the hospital to avoid the risk of severe acute respiratory syndrome coronavirus 2 infection. The present study investigated the influence of the COVID-19 pandemic on patients with colorectal cancer. Patients with colorectal cancer treated between January and December 2019 were classified as the pre-pandemic group (pre-group) and those treated between April 2020 and March 2021 as the post-pandemic group (pandemic group). The clinicopathologic features of patients who underwent surgery for colorectal cancer in the two groups were retrospectively compared. A total of 161 patients were enrolled: 79 In the pre-group and 82 in the pandemic group. Although no significant differences were observed in tumor location and surgical procedure between the two groups, circumferential lesions (P<0.001), colorectal stenting (P=0.016) and Stage IV classification (P=0.019) had a higher frequency in the pandemic group compared with the pre-group; additionally, surgical curability was significantly lower (P=0.036) in the pandemic group. The spread of COVID-19 has increased the incidence of patients with advanced colorectal cancer. To reduce this incidence, healthcare professionals should inform the general public not only about the risk of COVID-19, but also about the increased incidence of advanced colorectal cancer after the pandemic.

Coronaphobia: A barrier to ongoing cancer treatment?

INTRODUCTION

Increased stress levels caused by the pandemic might cause delays in cancer treatment. We conducted a survey among cancer patients undergoing treatment to evaluate their psychological wellbeing and treatment adherence during Coronavirus disease 19 (COVID-19) pandemic.

MATERIAL AND METHODS

Patients receiving active chemotherapy at a private oncology center between January and May 2021 were included. Healthy volunteers were employees of a district health directorate with no history of cancer or chronic disease. Treatment adherence was described as compliant if the prescribed treatment was received within a week and the information was gained from patient charts. Hospital anxiety and depression scale (HADS) and COVID-19 phobia scale (CP19-S) were administered to participants.

RESULTS

402 participants were included; 193 (48%) were cancer patients. The mean age of the participants was 44 years old and 68% of the participants were female. All participants' CP19-S mean score was 47.9. Patient group had significantly lower CP19-S (p = 0.006). Chronic disease and history of a shocking event were the factors associated with CP19-S. All participants reporting hospital anxiety were found to have significantly higher COVID-19 phobia levels (p < 0.05). Patients' mean HADS-anxiety score was significantly higher (7.3 vs. 6.5, p = 0.027). COVID-19 phobia was an independent factor increasing the level of anxiety and depression in both groups. Adherence to treatment was 100%.

CONCLUSION

The pandemic increased levels of anxiety, however, cancer treatment continued to be a priority in patients' lives. Strategies should be developed to support oncology patients cope with the pandemic and increase their courage to avoid treatment delays.

Mental Health and Adherence to COVID-19 Protective Behaviors among Cancer Patients during the COVID-19 Pandemic: An International, Multinational Cross-Sectional Study

A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer 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.