Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey

A Qualitative Descriptive Study to Assess Experiences and Care Needs of Patients With Cancer During the COVID-19 Pandemic

PURPOSE

To explore the experiences and unmet clinical needs of patients with cancer during the COVID-19 pandemic.

PARTICIPANTS & SETTING

The authors recruited patients with cancer who received cancer-directed therapy in March 2020 at a National Cancer Institute-designated comprehensive cancer center. Interviews with patients were conducted between June 2021 and January 2023.

METHODOLOGIC APPROACH

In this deductive-inductive descriptive qualitative investigation, participants completed a one-time 45-minute semistructured telephone interview via Zoom.

FINDINGS

The qualitative analysis revealed (a) a myriad of psychological stressors, (b) bolstered human connectedness, (c) disruptions to daily life, (d) clinical support and education from healthcare teams, and (e) looking ahead to postpandemic life. Participants experienced changes in health behaviors and material hardships but highlighted support from family, friends, and healthcare teams.

IMPLICATIONS FOR NURSING

The cohort of patients experienced significant distress and disruptions to their lives during the COVID-19 pandemic. Interventions implemented during an unanticipated event such as a pandemic need to be developed and tested to support patients with cancer.

Global Prevalence of Mental Health Problems Among Cancer Survivors: A Meta-Analysis From 31 Countries

BACKGROUND

With the improvement of medical treatment, the survival rate of cancer patients continues to rise; however, their psychological issues require further management. Currently, there is uncertainty regarding the prevalence of mental health problems among cancer survivors.

OBJECTIVE

To quantitatively summarize the global prevalence of mental health problems in cancer survivors.

METHODS

We searched CINAHL, PsychlNFO, Embase, Web of Science, and PubMed for studies reporting the prevalence of various mental health problems in cancer survivors who have survived at least 3 months. Subsequently, stratified analyses were conducted based on study design, region, cancer system, and time since diagnosis. Moreover, meta-regression was utilized to investigate sources of heterogeneity. We used Rstudio software 4.3.0, Stata 17.0 software and metaprop package.

RESULTS

A total of 147 studies involving 135,015 cancer survivors from over 30 countries were identified, primarily focusing on six mental health problems. Among 78 studies addressing anxiety, the prevalence was 24.4% (95% CI: 20.2%-28.8%). Among the 96 studies on depression, the prevalence was 23.7% (95% CI: 20.1%-27.4%). In the case of sleep disorders, 42 studies reported a prevalence of 34.1% (95% CI: 27.9%-40.6%). The overall prevalence decreased over time since diagnosis. Most of the analyzed data exhibited significant heterogeneity (I2 > 75%).

CONCLUSION

The analysis indicated that cancer survivors experience a diverse range of mental health problems, which were prevalent among them. The results emphasized the importance of recognizing and treating mental health problems in cancer survivors and served as a reminder for healthcare workers to address mental health problems in this population. The registration number was CRD42023466209.

Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study

PURPOSE

Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer.

METHODS

This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy.

RESULTS

The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms (r = 0.310) and anxiety (r = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, P = .070; 6-month β = .072, P = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, P = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, P = .023; 9-month β = .071, P = .068).

CONCLUSION

FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.

Financial hardship during the COVID-19 pandemic and increased receipt of commercial tobacco discount coupons among US adults who use commercial tobacco

INTRODUCTION

Many individuals experienced financial hardship during the COVID-19 pandemic; yet commercial tobacco (CT) sales increased in the USA. We examined how experiencing financial hardships relates to increased CT discount coupon reception during the pandemic.

METHODS

A nationally representative sample of 1700 US adults who used CT during the 12 months prior to the survey were surveyed online during January to February 2021. Participants reported if they had received more discount coupons for various CT products during (compared with before) the pandemic. They also reported whether they experienced six different types of financial hardships since the pandemic, and the total number of hardships experienced was counted. Weighted multivariable logistic regressions were used to examine the associations between financial hardships and increased coupon reception, adjusting for demographics and CT product use.

RESULTS

During the first 10-11 months of the pandemic, 21.3% of US adults who used CT during the 12 months prior to the survey reported receiving more CT discount coupons. Experiencing financial hardship during the pandemic was associated with higher odds of receiving more coupons for all types of CT products: every additional count of financial hardship was associated with higher odds of increased reception of discount coupons for all CT products (adjusted odds ratios ranging from 1.13 to 1.23 across products).

CONCLUSIONS

Over one-fifth of US adults who used CT received more discount coupons during the pandemic. Those facing financial hardships had higher discount coupon reception, suggesting potential targeted marketing to financially vulnerable individuals by the tobacco industry.

CFANet: Context fusing attentional network for preoperative CT image segmentation in robotic surgery

Accurate segmentation of CT images is crucial for clinical diagnosis and preoperative evaluation of robotic surgery, but challenges arise from fuzzy boundaries and small-sized targets. In response, a novel 2D segmentation network named Context Fusing Attentional Network (CFANet) is proposed. CFANet incorporates three key modules to address these challenges, namely pyramid fusing module (PFM), parallel dilated convolution module (PDCM) and scale attention module (SAM). Integration of these modules into the encoder-decoder structure enables effective utilization of multi-level and multi-scale features. Compared with advanced segmentation method, the Dice score improved by 2.14% on the dataset of liver tumor. This improvement is expected to have a positive impact on the preoperative evaluation of robotic surgery and to support clinical diagnosis, especially in early tumor detection.