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. 2022 Jun 7:12:901426.
doi: 10.3389/fonc.2022.901426. eCollection 2022.

16 Months Follow Up of Patients' Behavior and Mild COVID-19 Patterns in a Large Cohort of Cancer Patients During the Pandemic

Nawale Hajjaji  1   2 , Kathleen Lepoutre  3 , Sarra Lakhdar  1 , Stéphanie Bécourt  1 , Charlotte Bellier  1 , Emilie Kaczmarek  1 , Antonin Broyelle  1 , Sandrine Giscard  3 , Eric Lartigau  4
Affiliations

16 Months Follow Up of Patients' Behavior and Mild COVID-19 Patterns in a Large Cohort of Cancer Patients During the Pandemic

Nawale Hajjaji et al. Front Oncol. .

Abstract

Background: Acute severe forms of COVID-19 infection are more likely in cancer patients and growing attention has been given to the persistent symptoms of the disease after severe COVID-19. However, mild illness is the dominant clinical presentation of COVID-19 infection. To investigate patients' behavior and the short- and longer-term pattern of the disease in cancer patients with mild COVID infection, a longitudinal online survey was conducted for 16 months during the pandemic in a large cohort of cancer patients from a French COVID-19 hot spot. An online questionnaire was administered at three time points between the first wave of the pandemic in France and the fourth wave. The questionnaire was completed by 1415 to 2224 patients, which queried patients' demographics, their behavior, and COVID infection patterns. Seventy percent of the patients were female, and 40% had a comorbid condition. More than one-third of the participants had breast cancer, and half were survivors. The rate of infection was 30% during wave 1 and 10% in wave 4; most patients had a mild COVID-19 infection. Twenty-five percent of infected patients during wave 4 did not seek medical advice. At wave 4, 87% of the patients received at least one dose of vaccine. Systematic compliance to shielding measures decreased over time. The short-term pattern of mild COVID changed between wave 1 and wave 4. Twenty-two percent of infected patients experienced persistent signs for more than 6 months with a negative impact on sleep, social behavior, and increased consumption of stress-relieving drugs. Our results showed a high prevalence of long-lasting symptoms in cancer patients with mild COVID-19 infection and inadequate behavior toward the disease and prevention measures among patients.

Keywords: anti-COVID-19 vaccination; cancer patients; long COVID; mild COVID-19 infection; patients’ behavior; shielding measures.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow diagram. Cohort 1 is the longitudinal part of the study where online questionnaires were administered at three time points during the pandemic in France: the first wave, post wave 1, and wave 4. Cohort 2 gathered cancer patients from cohort 1 who completed the questionnaire at wave 4 and patients with newly diagnosed cancer during the pandemic (between May 2020 and July 2021). The left vignette shows the COVID-19 waves in France based on the curve of daily hospitalizations for COVID-19 nationwide.
Figure 2
Figure 2
Patients’ behavior toward COVID-19 infection. (A) Sankey diagrams of patients’ application of shielding measures during the pandemic (cohort 1), and of the medical care sought by infected patients (experiencing COVID-19-like symptoms) and asymptomatic patients. (B) Systematic application of shielding measures in the general population of the Hauts-de-France region (blue line) and among cancer patients (cohort 1, orange line) during the pandemic. The systematic wear of the mask was the indicator used for the general population using the French GEODE database. Among cancer patients, the systematic application of five shielding measures globally (wearing a mask, avoiding gatherings, hand washing, physical distance, coughing in the elbow) was indicated. (C) Testing among cancer patients in cohort 1 (upper graph) and the general population of the French Hauts-de-France region (lower graph). The proportion of cancer patients with clinical symptoms of COVID-19 infection tested for COVID is indicated per wave. The trend of testing in the general population of the same region is indicated as the number of weekly tests during the pandemic. ER, emergency room; GP, general practitioner; Center, Oscar Lambret cancer center.
Figure 3
Figure 3
Vaccination (A) kinetics in the general population in the Hauts-de-France region and (B) in cancer patients (cohort 2) at wave 4 (august 2021), with the number of doses received. Lack of vaccination was distributed according to patients’ motivations.
Figure 4
Figure 4
Clinical patterns of mild COVID-19 infection. (A) Symptoms associated with COVID-19 experienced by cancer patients in cohort 1 during wave 1 (in blue) and wave 4 (in orange). (B) Long-lasting COVID-19 symptoms among cohort 2 patients (at wave 4). *p<0.05; **p<0.01; ***p<0.001.
Figure 5
Figure 5
Proportion of patients in (A) cohort 1 (longitudinal cohort) experiencing insecurity, sleeping troubles, feeling irritable or the need to self-isolate, to consume stress-relieving drugs, alcohol, or tobacco during the pandemic at wave 1, post wave 1, and at wave 4. (B) Proportion of patients experiencing these feelings in cohort 2 (at wave 4) among patients tested positive according to the duration of COVID symptoms (less than 6 months in blue, or more than 6 months in brown). Mths: months; *p<0.05; **p<0.01; ***p<0.001.
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