ABSTRACT
Introduction Our objective was to compare the quality of life (QOL) in residents according to their cancer status, using questionnaires adapted to potential neurocognitive disorders (NCD) presence. Methods This multicenter cross-sectional study included residents aged 70 years and older able to communicate, with an estimated necessary number of subjects of 352. The study was conducted in two steps: first including residents with cancer and next a control group randomly selected among residents without any history of cancer matched on NCD and dependence status. QoL was assessed with different scales: QolAD if NCD, otherwise WHOQOL-OLD and QLQC30+ELD14 in the cancer group. Results Due to the COVID pandemic, the study was terminated early, and only 70 included residents had complete analyzable data. The participants had a median age of 85 years [70-99] and 20 were male. Regarding dependence status, 20 had an ADL between 0-2, 15 an ADL between 2.5-4.5, 34 an ADL between 5-6. Among the 42 residents in the cancer group, mostly cancer survivors. 13/42 residents in the cancer group had NCD (vs. 7/28 in the control group), 19/42 in the cancer group reported pain (vs. 16/28 in the control group). Conclusions Various obstacles have prevented from completing the study: low resident eligibility, difficulty in obtaining written consent, and finally the COVID pandemic which limited the availability of the nurse investigators and had impacted residents' QOL. This study could be redone at a distance from this pandemic if possible.
ABSTRACT
Background: Sudden COVID-19 pandemic has enforced social restrictions across the globe, including social distancing, curfews and total lockdowns, which persist in many parts of the world. Beyond these measures, cancer patients have faced up to the threat of the risk of severe COVID-19 infections and the adaptations of medical oncology practices, with potential impact on their psychological well-being. We aimed to follow Post-Traumatic Stress Disorder (PTSD) symptoms and other Patient-Reported Outcomes (PROs) over this period among cancer patients from the French COVIPACT study. Methods: The COVIPACT study (NCT04366154) included patients with solid/hematologic malignancy receiving medical treatment during the first lockdown in outpatient departments of two cancer centers. Patients were asked to fulfill validated questionnaires on PTSD symptoms (IES-R), insomnia (ISI), quality of life (FACT-G) and cognition (FACT-Cog) at baseline (M0, first lockdown, Apr/May 2020), 3 months (M3, postlockdown, Jul/Aug 2020) and 6 months (M6, second lockdown, Oct/Nov 2020). PTSD was defined as an IES-R score ≥33 and moderate/severe insomnia as an ISI score ≥15. Higher values on the FACT-G (range 0-108) and FACT-Cog (PCI subscale range 0-72) indicated better quality of life and cognition, respectively. Changes in PROs over time were assessed using mixed models for repeated measures. Results:Among the 734 patients included in COVIPACT, 579, 347 and 328 completed the questionnaires at M0, M3 and M6, respectively: median age, 64 years, 72% women, 59% metastatic status. Patients were mostly treated for breast (44%), lung, head and neck (20%), digestive (16%) and gynecologic cancers (11%). We observed a J-shaped evolution of PTSD over time, affecting 21.2% of patients during the first lockdown, 13.6% the post-lockdown and 23.6% during the second lockdown (p for time < 0.001). Moreover, patients reported linear deterioration of cognitive function over follow-up (p < 0.001). No change was observed in any dimension of quality of life (p for time = 0.06). 24.3%, 27.1% and 28.1% of the patients reported insomnia at M0,M3 and M6 (p for time = 0.35). At each time, PTSD was associated with more insomnia, worst quality of life and cognitive complain. At all the times, ≥50% of patients with PTSD reported insomnia compared to ≤23% in non-PTSD patients (p < 0.001). In addition, there was a clinically significant difference of ≥16 points on the FACT-G and ≥8 points on the FACT-Cog PCI between PTSD and non-PTSD patients (p < 0.001) at the all times. Conclusions: More than 20% of patients have developed PTSD during the different periods of lockdown, with strong association with poor quality of life, cognitive complain and insomnia. Psychosocial support promoting emotional resilience should be largely offered to cancer patients to prevent and/or reduce PTSD.