ABSTRACT
Background: In response to COVID-19, Quebec repurposed surgical care infrastructure and delayed many elective cancer surgeries. However, postponing cancer surgery is known to cause anxiety and distress. Methods: A qualitative study was conducted to understand patients experiences receiving surgical cancer treatment during the COVID-19 pandemic. Patients who underwent general surgery for cancer at the McGill University Health Centre between March 2020 and January 2021 were invited to one-to-one interviews. Patients were purposefully selected for maximum variation using quota sampling (i.e., targeting delay status, pandemic phase, cancer site, and clinical/ demographic characteristics) until interviews produced no new information (i.e., thematic saturation). Interviews were conducted using a semistructured guide, audio-recorded, transcribed verbatim, and analyzed independently by 2 researchers. Data were managed using MAXQDA2020 and analyzed according to inductive thematic analysis. Results: Interviews were conducted with 20 patients (mean age 64 yr;10 males;cancer sites: 8 breast, 4 skin, 4 hepato-pancreato-biliary, 2 colorectal, and 2 gastroesophageal). Surgery was delayed for 14 patients: 8 by the hospital, 4 by the patient, and 2 owing to a positive COVID-19 test. Thematic analysis revealed that patients considered their susceptibility to infection, hospital safety measures, and burden on health care resources when determining willingness to undergo surgery. Patients weighed these risks against the urgency of their health condition and recommendations of their provider. Changes to the hospital environment (e.g., COVID-19 preventative measures) and deviations from expected treatment (e.g., alternative treatments, remote consultations, rescheduled care) caused diverse psychological responses, ranging from increased satisfaction to severe distress. Patients employed coping strategies (e.g., reframing care interruptions, communicating with clinicians, information seeking) to mitigate distress. Conclusion: Changes in care during the pandemic elicited diverse psychological responses from patients undergoing cancer surgery. Patient coping was facilitated by open, consistent communication with clinicians, emphasizing the importance of patient-centred discussions regarding surgical delays within and beyond the pandemic.