ABSTRACT
Background: COVID-19's precise impact on cancer patients and their oncologic care providers remains poorly understood. This study aims at comparatively analyzing COVID-19's effect on cancer care from both a patient and provider perspective. METHODS: A multi-institutional survey was developed to assess COVID-19 specific concerns regarding treatment, safety, and emotional stress through 5-point Likert type prompts and open-ended questions before and after start of the pandemic. Wilcoxon signed-rank and -rank-sum tests were used to analyze before/after answers for providers and patients independently. Open-ended responses were assessed using inductive thematic analysis. RESULTS: The survey was completed by 104 (69.3%) patients and 50 (50%) providers. Patients demonstrated significant change in only 1 of 15 Likert prompts. Most significant were increased concern regarding susceptibility to infection [z=2.536, p=0.011] and concerns regarding their cancer outcome [z=4.572, p<0.001]. Non-physician providers demonstrated significant change in 8 of 13 Likert prompts, whereas physicians had all 13 Likert prompts change in the COVID-19 setting. Physicians believed care to be more poorly planned [z=-3.857, p=<0.001], availability of protective personal equipment (PPE) to be more limited [z=-4.082, p<0.001], and were significantly concerned infecting family members [z=4.965, p<0.001]. CONCLUSION: While patients had more difficulty coping with their cancer, they did not perceive significant differences in their actual treatment. This suggests the need for a renewed focus on patients' coping with cancer. Among providers, physicians more than any other provider group had a strong negative perception of COVID-19's impact on healthcare, suggesting the need for novel approaches to target physician burnout. (Table presented.)
ABSTRACT
Background: The COVID-19 pandemic has altered the priorities and capacities of health care systems worldwide, including how oncologic care is managed. Unprecedented changes to cancer care are being implemented to reducerates of infection and conserve health care resources, while providing optimal cancer care. To this date, nocomprehensive study has been conducted to assess the attitudes of both oncology patients and providerssurrounding these changes. Methods: A multi-institutional survey was provided to patients and oncology health care professionals.Demographics and clinical data were collected. Questions concerning treatment, safety, communication, andemotional stress before and after the pandemic outbreak was measured on a 5-point Likert scale. Open-endedresponses were collected, scored in a blinded fashion by three providers, and evaluated using Nominal GroupTechnique. Wilcoxon signed-rank test and Wilcoxon rank-sum test were used to compare provider and patientanswers where appropriate. Results: Patient concerns regarding susceptibility to infection [z=2.536, p=0.011] and their cancer outcome[z=4.572, p<0.001] were significantly increased during the COVID-19 period. Factors associated with increasedconcern were colorectal cancer, white race, stage 3 and 4, active treatment, and <1 year since diagnosis. However, providers were more concerned regarding outcome than patients, believing that cancer care is overall more poorlyplanned [z=-3.857, p=<0.001]. While patients were comparatively more worried about contracting COVID-19 thanproviders, providers felt less safe in clinic. Nonetheless, providers had more concern about patients contractinginfection than patients themselves, felt facilities were less sanitary, and had less confidence in the hospital overall.Among providers, strong concerns regarding availability of protective personal equipment [z=-4.082, p<0.001] andinfecting providers' families [z=4.965, p<0.001] were identified. Further, providers (significantly more than patients)felt that cancer care planning and communication were worse than before COVID-19. Conclusion: To our knowledge, this is the first multi-institutional survey to assess the impact of the COVID-19pandemic on patients and providers. Patients had more difficulty coping during the pandemic, suggesting anincreased need for emotional support. Nonetheless, patients did not perceive significant differences in their cancertreatment. This is in stark contrast to providers, who had major concerns regarding their ability to provide optimalcancer care, felt unprepared to handle the outbreak independent of the practice setting, and had personal safetyconcerns. This study suggests that more emotional support infrastructure for patients is required. Further, the bleakassessment of providers regarding effectiveness of their treatment and concerns for their personal safety raisesconcern for an increased risk of provider burnout, suggesting the need for novel targeted interventions.