The COVID-19 pandemic disrupted the healthcare system on a global scale, especially for individuals with cancer, given their need for ongoing treatments, surveillance, and weakened immune system. Cancer care was dramatically impacted by the pandemic, with requirements for social distancing, stay at home orders, switch to telemedicine, reduced numbers of individuals allowed in hospitals, and redistribution of resources.
A team of researchers, led by Ann Kirby, PhD, at Cork University Business School’s Department of Economics in Ireland, recently conducted a review of research studies to determine the impact of the COVID-19 pandemic on individuals with cancer. They published their results in the Supportive Cancer in Cancer journal, highlighting the dramatic social, psychological, and economic impact of the pandemic on individuals with cancer.
The researchers performed a systematic review of the literature, looking at articles published before April 2021. This search identified articles capturing the impact of the first wave of the pandemic, when restrictions were the strictest. They followed an adapted version of the Population, Intervention, Comparators, Outcomes, Context, Studies framework for systematic reviews. Five databases were searched to identify studies that focused on:
- adults who were either currently being treated for cancer or were cancer survivors;
- had outcomes related to the economic, social, and psychological implications of the COVID-19 pandemic, and were full-length research publications in English.
Data was extracted and reviewed using appraisal tools.
In total, 56 articles were identified after considering 5,383 articles identified through the databases. These articles were published across several different countries, with 20% coming from the United States. Most (64%) articles included participants with multiple types of cancer.
Psychological and social consequences of the pandemic focused on individuals’ worry and fears of their cancer and contracting COVID-19. For example, one study found that 62% of individuals reported that individuals were equally concerned about cancer progression and COVID-19 infection. Many studies reported participants’ concerns about cancer recurrence or progression because of COVID-related delays or disruptions. Studies suggested that individuals were fearful of going to the hospital, sometimes thought they were at higher risk for contracting COVID-19 infection than the general public, and concerned that their cancer care would be less important than protecting them from COVID-19.
While most individuals prioritized their cancer care over their concerns about COVID-19, some studies identified groups of individuals who delayed treatments and care because of concern for COVID-19. Notably, individuals from lower socioeconomic groups receiving palliative care, older, frailer with other illnesses, and those with an accurate understanding of immunosuppression were more likely to worry about COVID-19 infection more than their cancer.
Individuals receiving treatment in the previous six months reported higher distress, especially due to fears of COVID-19 infection. Sources of stress came from moving to virtual care options and attending oncology visits and treatment alone, rather than with a support person.
Anxiety was also commonly reported in studies, especially in women, older populations, those from lower income households, those with lower educational attainment, and those considered more vulnerable. Depression levels were higher in women, older populations, those from lower income households, and those who were unmarried or unemployed.
Social isolation and loneliness were major concerns for individuals due to lack of contact with loved ones, lack of social integration, fear of infection, economic concerns, and worries about the future. Women, younger patients, those with lower education, and those without young children were more likely to experience isolation and loneliness.
Studies showed that depression and anxiety frequently led to deliberate delays in care, especially when an individual was done with treatment and only receiving follow-up care. As individuals reported worse mental health, their overall quality of life also declined. When individuals’ treatment plans were changed because of alterations in how healthcare organizations provided care, individuals who already did not like uncertainty were even more affected by depression and anxiety. In this way, the COVID-19 pandemic exacerbated concerns people had already, on top of being a unique cause of distress.
Economic consequences of the COVID-19 pandemic varied by country and the type of government and insurance structures. In the United States, moving from in-person to telemedicine visits tended to reduce individuals’ out-of-pocket expenses and time. Individuals in the United States also reported concerns over losing their jobs and treatment costs and transportation to medical visits. The latter two concerns existed prior to the pandemic but were compounded by the financial uncertainty of the early part of the pandemic. These concerns were associated with purposefully delaying or avoiding cancer care. Individuals in the United States who were non-Hispanic white, married, more educated, and older were less likely to report financial burden.
The researchers summarized these findings by noting that the COVID-19 pandemic tended to exacerbate social, emotional, and financial concerns that individuals with cancer experienced prior to the pandemic. Since many of these concerns led some individuals to delay or postpone care, these outcomes are extremely concerning. While the researchers point to innovations in cancer care that may address these concerns – positive coping strategies and new ways of building social and peer support – these need to be more broadly implemented, especially within subgroups of individuals most at risk for these social, emotional, and financial outcomes.
Oncology nurses have witnessed these impacts on their patients, seeing firsthand how the pandemic has changed both the healthcare delivery system and their patients. Appreciating these differences can enliven existing calls to address patients’ quality of life, mental and social health, and financial burden.
Encouraging positive coping strategies, effective communication between patients and providers, and providing patient-centered informational support are possible ways to provide patients with tangible ways to address ongoing concerns related to the pandemic.