ABSTRACT
Background: Information on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), later termed coronavirus disease (COVID-19), first emerged by the end of 2019. As the pandemic spread, cancer patients were immediately recognized as a high-risk population with regard to COVID-19 infection. Moreover, epidemiological measures, like social distancing and lockdowns, additionally burdened patients with cancer. Even outside pandemic breast cancer patients are prone to psychological distress with prevalence ranging approximately 20-40%. This multicentric study aimed to examine the impact of COVID-19 pandemic on the level of distress among breast cancer patients in Croatia while the first wave of COVID-19 pandemic. Subjects and methods: Fife hundred forty-five breast cancer patients were offered to participate in the study. A total of two hundred and one patient, with disease stages ranging I-IV, completed the questionnaire. The questionnaire consisted of disease and socio-demographic characteristics followed by the Distress Thermometer and a problem list. The cut off value of 4 was used to define the high level of distress within Distress Thermometer. Results: High distress level was reported in 54.2% of patients. The most significant problems reported by the participants of our study affected emotions, causing worry, sadness, depression, fear, and nervousness. Additionally, specific practical problems emerged (e.g., child care, housing, and work/school), most probably partly due to the lockdowns and social distancing. Interestingly enough, none of the socio-demographic or disease characteristics were linked to the level of distress. Conclusions: During first wave of COVID-19 pandemic more than half of breast cancer patients, undergoing active oncologic treatment, experienced a high level of distress. Therefore, distress driven by the COVID-19 pandemic should be promptly addressed and additional psychological and social support, targeting specific practical and emotional problems, should be provided for those patients. All the more so as global COVID-19 pandemic far exceeded the duration of the first wave.
ABSTRACT
Goals: In a very short period of time, during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the coronavirus disease 2019 (COVID-19) became a great threat worldwide in terms of health, as well as social and economic aspects. From the beginning of the outbreak, patients with cancer were considered a high-risk population with regard to the COVID- 19 infection. Epidemiological measures imposed during the pandemic, such as social distancing and lockdowns, additionally burdened patients with cancer. Psychological distress is common in such patients. The prevalence of distress in patients with breast cancer ranges approximately 20–40%. The aim of this study was to examine the impact of the COVID-19 outbreak on the level of distress among patients with breast cancer in Croatia, during extreme epidemiological measures. We also sought to examine whether disease or socio-demographic characteristics were predictors for distress. Methods: A total of 545 patients with breast cancer were approached to participate in the study;201 patients completed the questionnaire with disease and socio-demographic characteristics. All patients were actively receiving systemic oncological treatment (neoadjuvant, adjuvant, or metastatic setting), with disease stages ranging I–IV. The level of distress was measured using the Distress Thermometer with a cut-off value of 4, followed by a problem list. The study was conducted from April 20, 2020 to May 24, 2020, while all extreme epidemiological measures (lockdown and strict social distancing) were ongoing and equally applied to all regions in Croatia. Results: High distress level was reported in 54.2% of patients. The most prominent problems were worry, fatigue, sleep, nervousness, fear, and child care. Highly distressed patients had more practical problems (child care, housing, and work/school) and emotional problems (depression, fear, nervousness, sadness, worry, and loss of interest for usual activities), than those in the low distress group. None of the socio-demographic or disease characteristics of the patients were linked to the level of distress. Conclusion(s): Even in a country with a favorable epidemiological situation, at the beginning of the COVID-19 pandemic, every second patient with breast cancer had a high level of distress. COVID-19- induced distress should be promptly addressed and additional psychological and social support, targeting specific practical and emotional problems, should be provided for those patients. Conflict of Interest: No significant relationships.
ABSTRACT
Background: In this study, we focused on communicating with cancer patients on active treatment during the first lockdown due to the COVID-19 pandemic and the patient’s main sources of pandemic information. Methods: In the first wave of the pandemic, during the first lockdown, we conducted an observational study in 8 of the 13 oncology centers in Croatia. The study is based on an anonymous self-report questionnaire designed for this study. It included 422 oncology patients, older than 18 years, who were in active oncology treatment at the time. To study the correlation between the patient’s perspective on communicating with medical staff during a pandemic, the preferred type of communication, and the main sources of pandemic information relative to clinical and sociodemographic data, we used univariate descriptive and bivariate analyzes. Results: In the first lockdown, our respondents communicated with the oncologist and oncology nurses mostly in-person (77.7% vs. 81%), and with the general practitioner mostly virtually, most often by phone (70.6%). Regardless of the pandemic, the majority of oncology patients (76.1%) prefer to communicate with an oncologist in-person, and most expressed satisfaction with communicating with medical staff during a pandemic. The choice of information sources and type of communication depends on the age, gender, income, education, and the seat of the disease of patients. Conclusions: For most of our respondents, in-person visits were the basic way of communicating with oncologists and oncology nurses. On the other hand, a virtual visit was the basic way to communicate with the general practitioner. As patients stated that, regardless of the pandemic, they prefer to communicate with the oncologist in-person, we can conclude that the virtual visit does not meet the needs of cancer patients who are in active oncology treatment. In our study men showed a tendency to communicate in-person, while women, breast cancer patients, younger people, highly educated people, and people of higher income are more prone to virtual visits and are more inclined to use the Internet as a source of information about a pandemic. Clinical trial identification: Approval number: 02/1-91/97-2020. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Background: The pandemic of coronavirus disease 2019 (COVID-19) was declared in March 2020. The first wave of the pandemic was marked by strict epidemiological measures: lockdown, social distancing, and self isolation. Cancer patients receiving systemic oncology treatments were considered a high-risk population regarding COVID19. These new circumstances posed possible obstacles for the treatment continuation, which in turn potentially led to an increase in distress. This study aimed to examine the impact of COVID-19 outbreak on a distress level among cancer patients. Methods: A total of 728 cancer patients, in 9 oncology centers, were approached to participate in the study. The study questionnaire with disease and sociodemographic characteristics was completed by 422 patients. Patients were stratified by cancer type: breast, gastrointestinal (colon, gastric, pancreatic), and other cancer types (lung, prostate, ovarian);and by disease stage, early or metastatic. All patients had to have an ongoing active oncology treatment which required regular visits to outpatient clinics or inpatient oncology departments. Distress level was measured using the Distress Thermometer with a cut-off value of 4. Results: There were 201 (47%) patients with breast cancer, 130 (32%) patients with gastrointestinal cancer (colon, pancreatic and gastric cancer), and 92 (21%) patients with other types of cancer (lung, prostate, ovarian). A total of 192 (46%) patients had early disease stage while 230 (54%) patients had advanced disease, respectively. A high distress level was reported in 189 (44.8%) of all patients. The breast cancer patients had significantly higher levels of distress when comparing with other types of cancer. There was no significant difference in distress level regarding disease stage. Conclusions: Almost every second cancer patient with ongoing active oncology treatment was highly distressed during the first wave of the COVID-19 pandemic, regardless of the disease stage. Breast cancer patients tend to have higher levels of distress when comparing with other cancer types. When evaluating distress during a pandemic one should take into account the possible impact of various aspects of COVID-19 disease and pandemic on a distress level in cancer patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.