ABSTRACT
Background/Purpose: During the COVID-19 pandemic, cancer patients and survivors have been recognized as populations at high risk for infection, disease development, and complications. As a result, significant changes were made to the delivery of cancer care including the delay of surveillance studies, conversion of in-person visits to telehealth, and cancellation of appointments. Methods: In order to improve our understanding of changes in cancer care due to COVID-19, we collected demographic information from and conducted brief, semi-structured interviews with five oncology providers and 12 cancer survivors. Cancer survivors also completed a health history survey. Survey data was summarized using descriptive statistics. Interviews were audio-recorded, transcribed, and are undergoing reflexive thematic analysis. Results: Providers were mostly female (80%) and of Asian descent (60%). Patients were mostly female (75%) and white (67%). The majority of patients had a college degree (83%), but employment status was mixed (42% full-time, 33% unemployed, 25% disabled). Patients had most commonly been diagnosed with breast cancer (33%) and were on active treatment (58%). Initial review of transcripts suggests that minor changes and brief delays to cancer treatments were common early in the pandemic. Additionally, many visits with members of the oncology team were converted to telehealth, which patients found to be as effective as and more convenient than in-person visits. However, ancillary services that require in-person visits (e.g., physical therapy) were more likely to be cancelled or significantly delayed. Conclusions and Implications: The COVID-19 pandemic resulted in brief disruptions to the delivery of radiation and chemotherapy. Telehealth was a useful substitute for many other types of visits, but was not a feasible solution in all cases, resulting in delays or cancellations of interventions focused on symptom management. Though such delays may not impact survival, they have likely increased survivors' risk for pain, diminished functional status, and decreased quality of life.
ABSTRACT
Objective: In early 2020, our research teams at Northwestern University, NorthShore University HealthSystem, University of Michigan, and Fox Chase Cancer Center prepared to launch the final year of interventions for an NCI-funded RCT titled REASSURE ME (R01 CA193331). This study examines the extent to which training in mindfulness helps men diagnosed with prostate cancer on active surveillance and their partners be able to cope with the uncertainties of this treatment approach. Challenges associated with COVID-19 and shelter-in-place orders abruptly halted in-person study activities, prompting our team to quickly pivot and rethink how best to proceed. Methods: Our strategy consisted of four primary components:( 1) examining COVID-19's impact on the research (what affect, if any, it had on the study's purpose, design, procedures, findings);(2) re-evaluating plans underway before COVID-19 struck (including recruitment, interventions, data collection, multisite communications);(3) determining if video-conferencing would be a viable delivery solution, and if so, how to adapt content for that platform;and (4) identifying best resources/practices for the virtual environment. Results: Preparations for an additional year of the study included: (1) holding site meetings to determine funding needs, (2) requesting an NIH no-cost extension, and (3) submitting modifications to each site's Institutional Review Board. Procedural changes/additions included: (a) online intervention trainings and creation of tutorial aids for the research team;(b) video-conferencing training sessions, tutorial aids, and ongoing technical assistance for research participants;(c) development of online versions of the treatment and control interventions;(d) postal delivery of paper-based intervention materials/supplies to research participants;(e) electronic/postal qualitative data collection;and (f) establishing a coordinating assistant to be on call for intervention facilitators during sessions. Conclusion: The unprecedented constraints of COVID-19 presented our team with the opportunity to re-envision and develop a new approach for online delivery of mindfulness that can be used by future researchers.