ABSTRACT
The novel coronavirus disease of 2019 (COVID-19) disrupted the healthcare delivery landscape with dramatic impacts on cancer patients and family caregivers (FCGs). Many safety measures were implemented to provide services to patients during the pandemic. However, the impact of these measures on the experiences of lung cancer surgery patients, FCGs, and their healthcare team is not well known. Therefore, the purpose of this study was to describe the changes and experiences with surgical care delivery from the patient, FCG, and surgical team perspectives. Methods: This mixed methods study included healthcare professionals, lung cancer surgery patients, and their FCGs from an NCI-designated Comprehensive Cancer Center. Data was collected between September 2020 through February 2021 using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences survey (patients and FCGs only). Key informant interviews with patients, FCGs, and surgical team were also conducted. Patients/FCGs were recruited from a randomized efficacy trial of a multimedia self-management intervention in lung cancer surgery. Qualitative data was analyzed using the conventional content analysis approach and demographic descriptive statistics for patients/FCGs were determined through baseline surveys from the randomized trial. Results: Our study participants (n=56) were predominantly English speaking (91%), non-Hispanic White (68%), Asian (14%), and Black (7%) lung cancer surgery patients/FCGs. Most participants achieved more than a high school diploma (77%), 33% were employed full-time, and 50% used Medicare. Providers (n=4) included a nurse practitioner and thoracic surgeons. We identified 5 constructs that were associated with cancer care delivery from perioperative to discharge: 1) increased diagnostic testing-COVID-19 test;2) visitor restrictions increased patients/FCGs mental health distress and decreased provider-FCG shared-decision making;3) communication barriers decreased for patients/FCGs due to use of telehealth resources (i.e., Hope Virtual, WhatsApp, FaceTime) which increased frequency of provider engagement throughout care continuum;4) patients/FCGs concerns and lack of education of COVID-19 risk factors impacted postoperative recovery;and 5) COVD-19 “elevated” the use and need for including telemedicine in standard of care practices. Moreover, patients experienced delays in treatment, isolation, lack of social support, financial hardship, and fear of death from COVID-19. FCGs also experienced psychological distress, financial hardship, fear of contracting COVID-19, and a heightened awareness of public health safety measures. Discussion: The COVID-19 pandemic created challenges to the cancer care delivery landscape for the surgical team and impacted the psychological and financial well-being of lung cancer surgery patients and their FCGs. While the long-term effects of the pandemic is unknown, opportunities to improve patient/FCG quality of life outcomes through targeted mental health/financial toxicity interventions is warranted.