ABSTRACT
Background: Cancer patients are at high risk of psychological problems and COVID-19 infection, which makes them even more vulnerable to mood disorders. Our objectives were to analyze the level of anxiety and depression among patients with advanced cancer during the COVID-19 pandemic and to analyze the association between sociodemographic, clinical, and psychological factors in patients with advanced cancer. Methods: A prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced unresectable or metastatic cancer who were candidates for systemic treatment were included. Patients completed demographic information and the Brief Symptom Inventory (BSI), Michel´s Uncertainty in Illness Scale (MUIS), Mental Adjustment to Cancer (MAC), and Cancer Worry Scale (CWS). Results: A total of 374 patients were recruited (April 2020-2021). The mean age was 64.2 years (34-88) and 48.7% were women. The most frequent were lung (30.7%) and colon (14.2%) cancers and most had metastases (78.6%). The most frequent therapy was chemotherapy (57.9%). The prevalence of anxiety and depression was 35% and 34%, respectively. Anxiety and depression levels were higher in women (p=0.001 and p=0.003, respectively). Patients <65 years (p=0.017) and with an oncologist-estimated survival of >18 months (p=0.033) had more anxiety symptoms. Logistic regression analysis revealed that women, patients with coping based on anxious preoccupation and hopelessness had higher risk of anxiety and depression (all, p<0.001). Conclusions: Patients with advanced cancer who start treatment during the COVID-19 pandemic experience high levels of depression and anxiety. Early diagnosis and the development of intervention strategies are needed especially in specific patient subgroups such as young women with long survival estimated times. Legal entity responsible for the study: The authors. Funding: This work was funded by FSEOM (Spanish Society of Medical Oncology Foundation). Disclosure: B. Obispo: Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: Fresenius;Financial Interests, Personal, Invited Speaker: Rovi. R. Hernandez: Financial Interests, Personal, Advisory Role: Amgen;Financial Interests, Personal, Invited Speaker: Servier;Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Merck;Financial Interests, Personal, Invited Speaker: Ipsen. P. Cruz: Financial Interests, Personal, Invited Speaker: Bristol;Financial Interests, Personal, Advisory Board: Boehringer Ingelheim. A. Fernandez Montes: Financial Interests, Personal, Advisory Role: BMS;Financial Interests, Personal, Advisory Role: MSD;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Servier;Financial Interests, Personal, Invited Speaker: Lilly;Financial Interests, Personal, Advisory Role: Lilly;Financial Interests, Personal, Advisory Role: AstraZeneca;Financial Interests, Personal, Invited Speaker: Pierre Fabre;Financial Interests, Personal, Invited Speaker: Merck. N. Piera Molons: Financial Interests, Personal, Invited Speaker: Grunenthal;Financial Interests, Personal, Invited Speaker: Kyowa Hakko Kirin;Financial Interests, Personal, Expert Testimony: Ordesa. V. Pacheco-Barcia: Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Invited Speaker: Merck;Financial Interests, Personal, Invited Speaker: Bristol-Myers Squibb;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Leo Pharma;Financial Interests, Personal, Invited Speaker: Kiowa Hakko Kyrin;Financial Interests, Personal, Invited Speaker: Grunenthal;Financial Interests, Personal, Invited Speaker: Prostakan;Financial Interests, Personal, Invited Speaker: Lilly. M.H. López de Ceballos: Financial Interests, Personal, Invited Speak r: Roche;Financial Interests, Personal, Invited Speaker: Eisai;Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: AstraZeneca. M. Antoñanzas Basa: Financial Interests, Personal, Other, Personal fees: AstraZeneca;Financial Interests, Personal, Other, Personal fees and no financial support: Novartis;Financial Interests, Personal, Other, Personal fees: Pierre Fabre;Financial Interests, Personal, Other, Personal fees and non-financial support: MSD;Financial Interests, Personal, Other, Personal fees and non-financial support: Sanofi;Financial Interests, Personal, Other, Personal fees: Pfizer. D. Lorente: Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Janssen;Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Sanofi;Financial Interests, Personal, Invited Speaker: Bayer;Financial Interests, Personal, Invited Speaker, Advisory, travel fees: Astellas;Financial Interests, Personal, Invited Speaker, Consultancy, travel fees: BMS;Financial Interests, Personal, Invited Speaker, Advisory: AstraZeneca;Financial Interests, Personal, Invited Speaker, Travel fees: Pfizer. A. Manzano Fernández: Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Leo Pharma;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Invited Speaker: Rovi;Financial Interests, Personal, Invited Speaker: Pharmamar;Financial Interests, Personal, Advisory Board: Grunenthal;Financial Interests, Personal, Advisory Board: AstraZeneca. S. Hernando Polo: Financial Interests, Personal, Invited Speaker, Advisory role: Pfizer;Financial Interests, Personal, Advisory Board: GlaxoSmithKline;Financial Interests, Personal, Advisory Board: Clovis;Financial Interests, Personal, Advisory Board: Pharmamar;Financial Interests, Personal, Invited Speaker, Advisory role: AstraZeneca. M. Gonzalez Moya: Financial Interests, Personal, Invited Speaker: Bristol;Financial Interests, Personal, Invited Speaker: MSD;Financial Interests, Personal, Invited Speaker: Sanofi;Financial Interests, Personal, Invited Speaker: Boehringer Ingelheim;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: Merck. All other authors have declared no conflicts of interest.