Protecting patients with cancer is an important component of public health measures to address the COVID-19 epidemic, especially as one new study has found that about one-quarter of people living with cancer were found to have post-traumatic stress symptoms.
Domenico Galetta, of IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy, presented the results of a study (Featured Poster FP604) designed to measure levels of general distress, depression, anxiety, and post-traumatic distress symptoms among patients with cancer.
The SARS-CoV-2 pandemic has had a tremendous impact on patients with cancer, Dr. Galetta said, mainly due to a reduction of hospital activities. Some declines, for example, are a decline in outpatient activity, reduction in available beds and in the load of clinical activities, and postponing cancer screening tests. Furthermore, there is increased risk of severe outcomes from COVID-19 in patients with cancer.
The study looked at 176 outpatients attending the IRCCS Giovanni Paolo II for cancer therapy. Participants were asked to complete The Hospital Anxiety and Depression Scale (HADs) and the Impact of Event Scale-Revised (IES-r). Brief structured questionnaires also examined socio-demographic and clinical details, as well as worries related to the effect of COVID-19 on patients’ lives.
The most common diagnosis was lymphoma (77 patients), followed by lung cancer (59 patients), and breast cancer (40 patients). The mean age of patients was 57.9.
More than one-half of patients (55%) were found to have a high level of general distress (HADS-G), with 44.5% reported a high level of depression (HAD-D), and 58.4% a high level of anxiety (HADS-A).
Approximately one-quarter of patients (23.7%) reported severed symptoms of post-traumatic distress. Specifically, women presented with higher levels for the IES-r total compared with men (27.3% vs. 18.4%).
“Women have been found to be more vulnerable to anxiety and PTSD, and these data confirm previous literature,” Dr. Galetta said.
Seventy percent of patients declared that their worries increased during the pandemic. Their greatest concerns were for the risk of getting infected while at the hospital (60%), the risk of infecting relatives coming back home (52%), the risk of delaying therapy (62%), and social distancing from their loved ones (53%). Also of concern were potential difficulties in contacting the oncologist if needed (66%) and financial difficulties (43%). The concerns were globally greater in women than men, with the exception of financial issues.
Mean questionnaire scores showed higher levels of depression (8.3 for lung vs. 7.1 for total population), anxiety (11.3 for lung vs. 8.4 for total), and distress (19.6 for lung vs. 15.5 for total) in patients with lung cancer. Probably Dr. Galetta said that this is likely because having lung cancer makes the patient feel more vulnerable and have a greater fear of COVID-19 infection, which can cause lung damage.
By comparing psychological distress levels between patients in 2018 with those in 2020, the study also showed that people living with lung cancer had higher levels of general distress, depression, and anxiety closely related to the pandemic.
“Special interventions to promote mental well-being in patients in this period of coronavirus pandemic need to be implemented as soon as possible, especially with regard to women and patients with lung cancer,” Dr. Galetta said.