A review of multiple studies found the COVID-19 exacerbated the economic, social and psychological difficulties that patients with cancer were already facing because of their cancer.
Patients with cancer regularly face economic, social and psychological impacts that were compounded by COVID-19. In a new study published in Supportive Care in Cancer, researchers reviewed approaches to minimize the impacts of COVID-19 on patients with cancer.
“Cancer patients were particularly vulnerable to [the pandemic’s] adverse impacts given their reliance on the healthcare system, and their weakened immune systems,” wrote researchers led by Ann Kirby, Ph.D., of the Department of Economics, Cork University Business School, University College Cork in Ireland.
The researchers conducted a systematic review to examine the social, psychological and economic impacts of the pandemic on patients with cancer with the included studies capturing the experience early in the pandemic when severe restrictions were in place worldwide.
The review included 56 studies, 96% of which were single-country studies. Overall, 20% of the studies were from the United States and 27% from Europe (18% from Italy.specifically). The studies mostly included patients with multiple cancer types (64%) followed by 18% focusing on breast cancer.
The social and psychological impacts of COVID-19 on patients with cancer that were reviewed included worry, fear, distress, anxiety, depression, social isolation and loneliness. Among the studies, there was a heightened sense of fear that the cancer would recur or progress because of care delays and disruptions.
Patients were also afraid of getting COVID-19. A study of Italian patients found 37.3% of patients with cancer were very or extremely afraid of going to the hospital and contracting COVID-19 and 24.5% were very or completely afraid that being protected against COVID-19 would be more important than continuing their cancer care.
While some patients were willing to postpone or delay their treatments for cancer, patients mostly prioritized cancer care over the fear of contracting COVID-19. According to the authors, the review found deliberate appointment delays were associated with depression and anxiety about cancer progression, and a delay to posttreatment follow-up or palliative care exasperated these feelings even more.
As a result of stay-at-home orders, quarantines and the fear of infection, a number of studies highlighted social isolation and loneliness experienced by patients with cancer. For instance, young cancer patients between the ages of 18 and 39 years reported feeling more isolated compared with before the pandemic.
“Some patients’ perceived risk of COVID-19 infection caused them to engage in extreme levels of social isolation where they had no visitors and lived alone,” Kirby and her co-authors explained. “For others, the pandemic exasperated underlying situations.”
In addition, the financial burden many patients with cancer feel was exasperated during the pandemic. While patients in the United States saved time and money due to the transition to telemedicine, treatment changes cost patients more in Jordan, the authors found. In countries that required negatives COVID-19 test results to attend appointments, patients were faced with additional costs that influenced decisions to undergo cancer treatments for some patients, particularly those in poorer countries.
The authors noted that since this review only included studies from the first wave of the pandemic, they adopted a short-term perspective. In addition, data collections across the studies varied and many used online methods that likely excluded patients who experienced technology barriers.
“Identification of the impact of COVID-19 on cancer patients from a psychological, social, and economic perspective following the pandemic can inform the design of timely and appropriate interventions and supports, to deal with the backlog in cancer care and enhance recovery,” wrote Kirtby and her co-investigators. “While the long-term effects and economic fallout for cancer patients are not easily quantified, they are real and further support is required to alleviate the issues cancer patients face.”