The cancer patient's perspective of COVID-19-induced distress-A cross-sectional study and a longitudinal comparison of HRQOL assessed before and during the pandemic

Abstract

Background: To permit timely mitigation of adverse effects on overall clinical outcome, it is essential to understand how the pandemic influences distress and health-related quality of life (HRQOL) in cancer patients during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: In this cross-sectional study, adult cancer patients, without COVID-19 symptoms, completed a 13-item questionnaire about the pandemic's impacts on distress and everyday-life; associations with age, sex, or impaired HRQOL were then assessed by binary logistic regressions. In a subsample of patients with HRQOL assessment available from both before and during the pandemic, we evaluated the pandemic's impact on longitudinal changes in HRQOL reported within 6 months before versus during the COVID-19 lockdown using McNemar's test, and thresholds for clinical importance.

Results: We consecutively enrolled 240 patients with solid (50%) or hematological (50%) cancers. Median age was 67 years, 46% were females. The majority ranked heeding their health (80%) and keeping their appointment schedule in hospital (78%) as important. Being younger than 60, or aged 60-70 was independently associated with limitations in everyday life (OR = 3.57, p < 0.001; and 2.05, p = 0.038); female individuals and those with restricted emotional functioning were more distressed by the COVID-19 situation (OR = 2.47, p = 0.040; and 3.17, p = 0.019); the latter group was also significantly more concerned about being a patient at risk (OR = 2.21, p = 0.029). Interestingly, in a subsample of patients (n = 47), longitudinal comparisons pre- versus during the pandemic revealed that HRQOL was not substantially affected by the pandemic.

Conclusion: Particularly younger and female cancer patients, and those with impaired emotional functioning are distressed by COVID-19. During the first COVID-19 lockdown, cancer patients remained predominantly resilient. This analysis highlights the need to mitigate distress situations in vulnerable patients and thereby enhance resilience during pandemics.

Keywords: cancer patients; corona virus disease 2019; distress; emotional well-being; health related quality of life; survey.

FIGURE 1

Answers to the survey of COVID‐19’s impact on cancer patients’ distress and everyday life. Proportion of patients answering “very much” or “quite a bit” in the survey

FIGURE 2

Stratification by age and sex of the patients’ answers in the survey of COVID‐19’s impact on cancer patients’ distress and everyday life. Proportion of patients answering “very much” or “quite a bit” stratified by (A) age subgroups and (B) sex. Note that patients younger than 60 years and those aged 60–70 years reported significantly greater limitations in everyday life (p < 0.001, and p 0.021), while we observed no differences by age in the responses to any other question. Female patients reported significantly greater limitations in everyday life (p = 0.047) and were significantly more strongly distressed by the COVID‐19 situation (p 0.008). In contrast, the responses to all other questions did not differ significantly between females and males. Red: significant differences in univariable linear regression (for odds ratios, see Figure 3A). Δ differences between categories, ***p < 0.001, **p < 0.001, *p < 0.01

FIGURE 3

Association between sex, age, and HRQOL on five items of the survey of COVID‐19’s impact on cancer patients’ distress and everyday life. Depiction as odds ratios with 95% confidence intervals. Significant associations are depicted in black, not significant ones in gray. (A) Univariable model and (B) multivariable model adjusted for age, sex, and HRQOL. Females compared to males. Age subgroups compared to individuals older than 70. EORTC‐QLQ‐C30 dimensions (summary score, global QOL, and physical and emotional functioning) compared between individuals with and without impairments. Additional details see supporting Table S1‐S6

FIGURE 4

Longitudinal changes in emotional functioning assessed in 47 patients before and during the COVID‐19 lockdown. Scores during lockdown are classified in two ways: (A) improvement versus stable versus deterioration in score, and (B) scoring as within norm versus as impaired. Note that all deteriorations (n = 14) occurred in patients that had not reported restrictions in their assessment prior to the COVID‐19 lockdown. Of these 14 patients, five became impaired, while nine remained within the norm. In contrast, of the twelve patients who had reported impaired emotional functioning before the COVID‐19 lockdown, none deteriorated, while seven improved (but four remained impaired), and five remained stable. A large proportion of patients remained stable (n = 22, 46%). Red: impaired. Gray: not impaired or stable. Green: improved. Orange: deteriorated