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1.
Supportive Care in Cancer ; 30:S26, 2022.
Article in English | EMBASE | ID: covidwho-1935808

ABSTRACT

Introduction A substantial proportion of cancer survivors experience a relatively high symptom burden. During the COVID-19 pandemic, study purposes were to identify distinct symptom profiles in cancer survivors and evaluate for differences among these symptom profiles in QOL outcomes. Methods Survivors (n=1145) completed questionnaires that evaluated: depression, state anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive impairment, and pain. QOL was assessed using the QOL Scale-Patient Version. Latent profile analysis was used to identify distinct symptom profiles (i.e., latent classes) using the severity scores from each of the symptom measures. Differences in QOL scores were evaluated using analysis of variance. Results Four distinct symptom profiles were identified (i.e., none (28.6%), low (37.7%), high (25.9%), very high (7.9%)). Compared to the none class, survivors in the other three classes were younger, more likely to be female, had a higher comorbidity burden, and a poorer functional status. Differences among the four classes in physical, psychological, social, and spiritual well-being, as well as total QOL scores followed the same pattern (none > low > high > very high). Conclusions Findings suggest that almost 35% of cancer survivors were experiencing a high to very high symptom burden during the COVID-19 pandemic. As symptom burden increased in these survivors, decrements in QOL increased in a stepwise fashion.

2.
Supportive Care in Cancer ; 30:S26, 2022.
Article in English | EMBASE | ID: covidwho-1935807

ABSTRACT

Introduction COVID19 cancelled in-person breast cancer support in Australia. Text messages are effective at providing health support. Aim: Evaluate cost, uptake, reach and utility of a 3-month co-designed (consumers/clinicians/ researchers) lifestyle-focused text message program 'EMPOWER-SMS'. Methods Participants were recruited (Apr'20-Feb'21) via breast cancer organisations' social media and emails. Inclusion: Adults, finished active breast cancer treatment (surgery/chemotherapy/radiotherapy), lived in Australia, owned a mobile phone, sufficient English for e-consent. Exclusion: metastatic breast cancer. Online survey at baseline: Demographics and postcode (coded to Index of Relative Socio-economic Advantage and Disadvantage [IRSAD];1 least to 5 most advantaged). At 3-months: program feedback for ease-of-understanding, utility, perceived health management (5-Point Likert Scale;strongly [dis]agree), open-text feedback (coded thematically). Results Ads cost $2641. Participants' (N=845) mean age: 59±10yrs (range 30-87yrs), 48% resided in less advantaged areas (IRSAD 1-3). Survey participants (n=452) agreed/strongly agreed EMPOWERSMS was easy-to-understand (99%), useful (83%), helpful for managing health (69%), exercise (70%), healthy diet (70%). Key themes: 'feeling supported/less lonely', 'friendly reminders', 'sad it ended', 'some messages too simple'. Conclusions With low cost ($3.1/enrolment), 845 diverse participants enrolled and found it useful, overcoming support barriers during COVID19.

3.
Supportive Care in Cancer ; 30:S25, 2022.
Article in English | EMBASE | ID: covidwho-1935805

ABSTRACT

Introduction High levels of stress are common during the COVID-19 pandemic. Less is known about levels of stress in cancer survivors. Study purposes were to identify distinct stress profiles in cancer survivors and evaluate for differences among these stress profiles in symptom burden. Methods Survivors (n=1145) completed stress, social isolation, and loneliness questionnaires to determine the stress profiles (i.e., latent classes), using latent profile analysis. Differences in common symptoms (i.e., depression, anxiety, fatigue, sleep disturbance, cognitive impairment, pain) were evaluated using parametric and non-parametric tests. Results Four distinct stress profiles were identified (i.e., none (51.3%), low stress and high loneliness (24.4%), high stress and high loneliness (14.0%), very high stress and very high loneliness (10.3%)). While loneliness scores were high, social isolation scores did not exceed the clinically meaningful cut point. Significant differences were found among the four classes in the severity of depression, anxiety, morning fatigue, cognitive impairment, and pain interference. Compared to none class, the other three classes reported higher sleep disturbance and evening fatigue scores. Conclusions Findings suggest that COVID-19 pandemic-associated stress and loneliness are experienced differently across a large sample of cancer survivors. Higher levels of stress and loneliness are associated with a significantly higher symptom burden.

4.
Supportive Care in Cancer ; 30:S31, 2022.
Article in English | EMBASE | ID: covidwho-1935797

ABSTRACT

Introduction Telehealth-based supportive care has proliferated, particularly during COVID-19. However, research on the use of these resources among older adults, who are the majority of cancer survivors, is limited. This study utilized online semi-structured interviews to gather older cancer survivors' use and perceptions of telehealth-based supportive care. Methods Participants were recruited through ResearchMatch. Content analyses were conducted by two independent coders for identification of common themes. SPSS IBM 27.0 was used for descriptive analyses. Results The majority of participants (n=21;mean age=73.5±4.9) were female (57%), White (90%), and had a variety of cancer diagnoses. Ten (47.6%) survivors had prior experience with telehealth use. More than half (52.3%) of survivors reported interest in using telehealth for symptom management. One-third of survivors were interested in telehealthbased supportive care for nutrition, exercise, screening, and stress management. Older cancer survivors noted the convenience of telehealth, yet expressed feelings of disconnect with supportive care providers and preference for in-person appointments. Conclusions These findings suggest that older cancer survivors are divided in their use and perceptions of telehealth for supportive care. Additional efforts to establish the most appropriate uses and distribution of telehealth-based supportive cancer care for older cancer survivors post-COVID-19 are warranted.

5.
Supportive Care in Cancer ; 30:S159-S160, 2022.
Article in English | EMBASE | ID: covidwho-1935776

ABSTRACT

Introduction Our objective was to compare the quality of life (QOL) in residents according to their cancer status, using questionnaires adapted to potential neurocognitive disorders (NCD) presence. Methods This multicenter cross-sectional study included residents aged 70 years and older able to communicate, with an estimated necessary number of subjects of 352. The study was conducted in two steps: first including residents with cancer and next a control group randomly selected among residents without any history of cancer matched on NCD and dependence status. QoL was assessed with different scales: QolAD if NCD, otherwise WHOQOL-OLD and QLQC30+ELD14 in the cancer group. Results Due to the COVID pandemic, the study was terminated early, and only 70 included residents had complete analyzable data. The participants had a median age of 85 years [70-99] and 20 were male. Regarding dependence status, 20 had an ADL between 0-2, 15 an ADL between 2.5-4.5, 34 an ADL between 5-6. Among the 42 residents in the cancer group, mostly cancer survivors. 13/42 residents in the cancer group had NCD (vs. 7/28 in the control group), 19/42 in the cancer group reported pain (vs. 16/28 in the control group). Conclusions Various obstacles have prevented from completing the study: low resident eligibility, difficulty in obtaining written consent, and finally the COVID pandemic which limited the availability of the nurse investigators and had impacted residents' QOL. This study could be redone at a distance from this pandemic if possible.

6.
Supportive Care in Cancer ; 30:S158-S159, 2022.
Article in English | EMBASE | ID: covidwho-1935775

ABSTRACT

Introduction Older (65+) cancer survivors have unique complications after chemotherapy, including physical and cognitive impairments and geriatric syndromes. Survivorship research has generally focused on younger and urban populations. We explored the survivorship needs of rural older adult survivors. Methods Thirteen rural older adults who finished curative-intent chemotherapy completed open-ended interviews and health surveys. Transcripts were coded independently by two coders using thematic analysis. Results Mean age was 74 (SD=5.1). Most participants were non-Hispanic White (92.3%), female (69.2%), and married (46.2%). All had health insurance and 76.9% had an annual income <$50k. Most were diagnosed with colon (46.2%) or lung (23.1%) cancer. Themes (Table 1) included: 1) No survivorship care plan developed (100%), 2) No coordination between primary and oncology team (100%), 3) Symptomatic toxicities present (100%), 4) No discussion on long-term chemotherapy effects (61.4%);5) Financial challenges (53.8%), 6) Isolation due to COVID19 pandemic (38.5%), 7) Organizational barriers to care (30.8%), 8) Patient does what doctor says (23.1%), and Recommendations included: 1) referral to support groups (23.1%), 2) discussion on survivorship care (23.1%), and 2) information on exercise (15.4%) Conclusions Rural older survivors have unmet survivorship needs. Aging-sensitive interventions may lead to improved survivorship health post-treatment among rural older adult survivors.

7.
Sleep ; 45(SUPPL 1):A74, 2022.
Article in English | EMBASE | ID: covidwho-1927391

ABSTRACT

Introduction: Challenges associated with recruiting participants in a longitudinal research study have been recognized yet remain a major barrier for researchers. The current study details strategies used in recruiting a heterogenous sample of cancer survivors with insomnia from multiple clinical sites, referral sources and outreach. Methods: Enrollment goals were 158 participants over 3 years (June 2019 to May 2022). Recruitment strategies included 1) face-to-face (FTF) recruitment at hospital clinics;2) posting recruitment flyers in clinical settings;3) completion of insomnia screening instrument at community clinic sites;4) research registries;5) institutional social media outreach;6) community events;7) PI interview and request for study volunteers in local newspaper;and 8) ongoing engagement and communication with recruited participants. Results: 108 of 158 participants have been recruited and completed baseline surveys;9 participants dropped out. To date, 42 of 49 (85.7%) participants have completed the 12-month study. June 2019 through December 2019 FTF recruitment occurred, where 104 were eligible and 32 (30.76%) were enrolled. Due to changes in study personnel and the COVID pandemic restricting access to in-person recruitment and enrollment, the study pivoted to develop protocols for electronic consent and enrollment using video conferencing. In addition, research databases, institutional social media, community events and local newspaper were utilized, where 76 of 239 (31.79%) interested participants enrolled. The most effective recruitment strategies included on-site FTF recruitment (57.9%) and local newspaper interview (13.88%). The local newspaper interview was the most cost-effective considering personnel costs associated with FTF recruitment. Conclusion: Despite the onset of the COVID pandemic during the recruitment phase, we were able to pivot and employ innovative techniques to meet our targeted enrollment goal for the projected study deadline. FTF recruitment, perceived value by clinic staff in benefitting cancer survivors, and participants' acceptance of video-conferencing were significant contributors. The importance of building and maintaining relationships with providers and nurses in local clinical sites cannot be underestimated.

8.
Pediatric Blood and Cancer ; 69(SUPPL 2):S103-S104, 2022.
Article in English | EMBASE | ID: covidwho-1885443

ABSTRACT

Background: Children with cancer and their families from rural and non-urban areas face unique challenges across the continuum of care, from active treatment to survivorship. Oklahoma is a highly rural state with thirty-four percent of residents living in non-urban areas. Therefore, given the known burden of late effects, health equity for this population requires attention to potential geographic disparities in optimal follow-up care in order to mitigate adverse health outcomes. Objectives: The primary purpose of this study was to construct a childhood cancer survivorship cohort in Oklahoma, through the integration of cancer registry, electronic health record, and geospatial data, and identify potential disparities in optimal follow-up care among survivors from non-urban areas. Design/Method: The Oklahoma Childhood Cancer Survivor Cohort was based on all patients <18-years-old at diagnosis captured by the cancer registry between January 1, 2005 and September 24, 2014 (to allow for at least seven years of follow-up data for all survivors). Patients with documented death or relapse, non-analytic cases, and those not seen in the pediatric oncology clinic were excluded. The primary outcome was whether survivors were seen in the pediatric oncology clinic between 2020-2021. To assess the potential impact of the COVID-19 pandemic, clinic attendance from 2018-2019 was also analyzed. The primary predictor of interest was rurality, defined by Rural-Urban Commuting Area coding based on zip code. Other explanatory variables included age, gender, race/ethnicity, late effects risk strata, and primary diagnosis. Results: A total of three-hundred and twenty-one survivors met eligibility criteria, of whom 41.1% (n = 132) were not seen in the pediatric oncology clinic between 2020-2021. There were significant differences (p = 0.036) in optimal follow-up care with 53% of survivors from large towns (n = 64) and 45% of survivors from small town/isolated rural areas (n = 49) without a documented clinic visit compared with 36% of survivors from urban areas (n = 205). There were no significant differences in follow-up by race/ethnicity, gender, age at diagnosis, or late effects risk strata. In the two years preceding the COVID-19 pandemic, 31% of survivors were not seen in the clinic with observed differences among survivors from urban, large town, and small town/isolated rural areas at 25%, 47%, and 26% with suboptimal follow-up, respectively (p = 0.011). Conclusion: Survivors from non-urban areas were less likely to receive optimal follow-up care compared to survivors from urban areas. The COVID-19 pandemic worsened optimal follow-up care and disproportionately affected survivors from large town and small town/isolated rural areas.

9.
Journal of Oncology Pharmacy Practice ; 28(2 SUPPL):40, 2022.
Article in English | EMBASE | ID: covidwho-1868954

ABSTRACT

Introduction: Around 1 in 10 childhood cancer survivors who receive an anthracycline develop a symptomatic cardiac event over time.1 Dexrazoxane, a free radical scavenger, has been shown to reduce surrogate markers of cardiac damage in children and young people receiving anthracycline chemotherapy.2 In February 2020, NHS England (NHSE) published a new clinical commissioning policy entitled: “Dexrazoxane for preventing cardiotoxicity in children and young people (under 25 years) receiving high-dose anthracyclines or related drugs for the treatment of cancer”.1 Given uncertainties regarding the robustness of the supporting data,1,2 a general unfamiliarity with the product and the timing of the publication of the policy (at the start of the COVID-19 pandemic) we hypothesised that these factors may all have impacted on the speed and degree of its adoption. Consequently we decided to undertake a survey of practice, with the aim of exploring awareness of the policy and use of the drug amongst UK TYA centres. Methods: A short questionnaire was designed using the www.onlinesurveys.ac.uk platform. The questionnaire was sent electronically to senior oncology/ haematology pharmacists from all 17 TYA Cancer Centres in the UK in March 2021 and was kept open for six weeks to allow centres sufficient time to respond. Responses were transferred to Microsoft Excel for data analysis. Results: Responses were received from all 17 UK TYA centres. All centres in England (n=13) were either very aware (69%) or somewhat aware (31%) of the dexrazoxane commissioning policy. The majority (three out of four) of the centres from the devolved nations were unaware of the policy. Five centres (29%) had used dexrazoxane as a cardioprotectant since February 2020 and a further five centres (29%) were considering its use. Reasons for not using the drug included: unconvinced by efficacy data (n=4), concerned re short and long-term side effects (n=3). Of those centres that had used the drug, three had only given it to 1-3 patients, one centre had given it to 7-9 patients and one centre had given it to >9 patients. None of the centres had a TYA Unit policy or guideline for the use dexrazoxane as a cardioprotectant, although two were in the process of writing one. Furthermore, although stipulated in the commissioning policy, only three out of five centres using the drug required MDT discussion prior to use. From a clinical perspective, there was a lack of consensus as to when in the treatment pathway to start the drug (i.e. with cycle one of chemotherapy or when a threshold dose had been reached). And from a practical perspective, concerns were raised about the short shelf-life of dexrazoxane and the workload implications for aseptic units. Conclusions: Despite generally good awareness of the dexrazoxane commissioning policy, use of the drug by TYA centres has been limited to date and clinical practice has not uniformly matched the recommendations contained within the policy. Further work is required to explore reasons for the slow and variable uptake and to also investigate potential differences in practice between TYA and paediatric centres.

10.
Eur J Cancer Care (Engl) ; : e13624, 2022 May 23.
Article in English | MEDLINE | ID: covidwho-1861298

ABSTRACT

OBJECTIVE: We aimed to determine the feasibility and benefits of a videoconferencing-based home exercise programme to improve health-related quality of life (HRQOL), posttraumatic growth and physical strength levels of paediatric cancer survivors during the coronavirus disease 2019 (COVID-19). METHODS: Eight paediatric cancer survivors participated in the intervention for 8 weeks. The programme comprised home exercise sessions administered using Zoom, a videoconferencing platform. The supervised exercise sessions were performed two times per week; the participants were taught to perform joint exercises at home for the remaining 5 days of the week. HRQOL, posttraumatic growth and physical strength levels were assessed at baseline and after the intervention. RESULTS: The rates of recruitment, retention and attendance were 52.9%, 88.9% and 98.4%, respectively. There were no cases of adverse events. The programme significantly improved flexibility (z = -2.21, p = 0.03), muscle strength (z = -2.67, p = 0.01) and power (z = -2.41, p = 0.02) among five domains of physical fitness measured using a physical activity promotion system and also improved total physical strength (z = -2.67, p = 0.01). Posttraumatic growth decreased slightly, whereas HRQOL improved slightly; however, the change was not statistically significant. CONCLUSION: The study findings present preliminary evidence of the feasibility and benefits of this videoconferencing-based home exercise programme among paediatric cancer survivors.

11.
Psycho-Oncology ; 31(SUPPL 1):101, 2022.
Article in English | EMBASE | ID: covidwho-1850164

ABSTRACT

Background/Purpose: Prior to the pandemic, patients with lung cancer commonly experienced stigmatization, high symptom burden, and unmet supportive care needs, placing them at increased risk for psychosocial morbidities during COVID-19. These risks necessitate investigation into how lung cancer patients have been coping during the pandemic. Methods: This study investigated COVID-19-related burden and behavioral coping utilized by 65 lung cancer patients receiving treatment at an NCI-designated Comprehensive Cancer Center between August 2020 and June 2021. Measurements included selfreport demographics, COVID-19 burden (Impact of COVID-19 Pandemic in Cancer Survivors Questionnaire, Penedo et al., 2020), psychosocial well-being (PROMIS Anxiety4a and Depression4a), and coping strategies (Brief COPE, Carver 1997). Results: Most participants identified as female (n = 43), non- Hispanic White (n = 53), partnered (n = 38), and diagnosed with Non-Small Cell Lung Cancer (n = 45);and most reported feeling anxious about contracting COVID-19 (n = 38;58.5%) and concerned that their cancer status increased their risk of dying (n = 47;72.3%). However, average PROMIS T-scores for anxiety (M = 53.59, SD = 9.05) and depression (M = 51.19, SD = 8.30) were similar to normed national averages. Participants primarily endorsed acceptance, active coping, and the use of emotional support coping strategies. Higher total COVID-19 burden was associated with greater use of venting, behavioral disengagement, and self-blame coping strategies. Higher total COVID-19 burden was associated with greater anxiety (r = 0.489;p < 0.001) and depression (r = 0.414;p < 0.001). Greater anxiety was associated with higher use of religion, venting, denial, substance use, and selfblame coping strategies. Greater depression was associated with greater reliance on instrumental support, venting, denial, substance use, and self-blame strategies. Conclusions and Implications: Participants recognized their heightened risks and utilized effective coping strategies during COVID-19. Use of acceptance, active coping, and emotional support may impact lung cancer patients' appraisals of COVID-19 and psychosocial wellbeing.

12.
Psycho-Oncology ; 31(SUPPL 1):68-69, 2022.
Article in English | EMBASE | ID: covidwho-1850162

ABSTRACT

Background/Purpose: Provision of education about selfmanagement to cancer survivors is a critical component of quality survivorship care and may improve survivors' ability to understand common/distressing symptoms, learn self-management strategies, and improve quality-of-life. Traditionally, education about psychosocial issues has occurred in clinical settings via in-person meetings with health care professionals. However, social-distancing restrictions from the COVID-19 pandemic, particularly in hospital settings, have significantly limited survivors' access to educational experiences. Methods: To address this issue, members of a survivorship center at a large healthcare system developed and delivered a 3-part series of psychoeducational webinars for cancer survivors addressing 1) Health Behaviors, 2) Mental Health, and 3) Long-term Late-Effects. Each webinar was 1-h long and offered at time deemed convenient for survivors based on pre-seminar surveys administered to 50 survivors inquiring about preferences for webinar content, format, length, and timing. All sessions were delivered via password-enable Zoom meetings, which were recorded and posted online, allowing attendees to review sessions and reach those who were unable to attend original presentations. Results: The virtual webinars were attended by 19, 18, 25 (total = 62) survivors respectively. A post-webinar survey was completed by 15 attendees (breast = 4, colorectal = 3, gynecological = 1, healthcare professional = 4, and other = 3). Most attendees were within 5 years of their diagnosis (94%), over the age of 50 (80%), and female (95%). Results of the survey indicated that attendees felt the Zoom platform was acceptable (100%), information was helpful (75%), well-organized (75%), and speakers were knowledgeable (75%). Importantly, attendees indicated they learned important survivorship self-management skills (90%). Conclusions and Implications: Results indicate survivors were satisfied with the format, content, and speakers, and learned important survivorship skills. However, respondents also suggested allowing more time for the sessions (90 vs. 60 min) and for Q and A. Future efforts will focus on attracting more, diverse attendees, increasing the length of the webinars, including patient/survivor/ advocate presenters, and adding new topics.

13.
Psycho-Oncology ; 31(SUPPL 1):61-62, 2022.
Article in English | EMBASE | ID: covidwho-1850159

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.

15.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816941

ABSTRACT

Purpose: Determine the role of social determinants of health (SDOH), including socioeconomic status (SES) (education, income in predicting intent to vaccinate for COVID-19 among a diverse community-based population, over sampled for cancer survivors in Connecticut (CT). Background: Race, ethnicity, and the SDOH (e.g., food insecurity, housing instability, trouble paying utilities bills) have a known impact on COVID-19 incidence, morbidity, and mortality. Although the impact on cancer survivors is not as well understood, this population may also face disproportionately severe outcomes. To our knowledge, there are no published studies that address intention to vaccinate in community based populations that are predominantly African American/Black (AA) or Hispanic/Latinx (H/L), nor in the cancer survivors who live in these communities. Prior studies have suggested that some vulnerable populations have lowered willingness to vaccinate (e.g., for influenza) than other groups. This study will explore the role of the high burden of SDOH barriers and selected socio-cultural factors such as perceived risk, medical mistrust, and source of health information. Methods: Data for this study are from 252 CT residents, collected from August - December, 2020 using Qualtrics, an online survey platform. Using an extensive network of community partners, we recruited through list serves and social media, targeting communities known to be most impacted by the pandemic. The intent was to enroll a population that was similar to the racial/ethnic sociodemographic profile of the city of New Haven, while oversampling cancer survivors. Using SAS 9.4, we conducted descriptive and multivariate analyses to identify the role of SDOH in willingness to vaccinate. Results: The study population was disproportionately African American/Black (23.5%) and Hispanic/Latinx (17.5%) and included 83 (32.9%) cancer survivors. In this high-risk population, 38.9% of the sample were unwilling or uncertain whether they would vaccinate against Covid-19 in the future. In multivariate adjusted model, individuals reporting at least one SDOH barrier (food insecurity, trouble paying utilities bills, or housing instability) were significantly less likely to vaccinate (odds ratio=2.26;95% Confidence Interval 1.17-4.36). Other significant predicators included low perceived risk and lacking confidence in information provided through the health care system. Conclusion: Social determinants of health play a critical role in predicting intent to vaccinate for COVID-19. Special efforts are needed to ensure that vulnerable populations understand their individual risk, the benefits and risks of getting the COVID-19 vaccine, with interventions aimed at enlisting trusted entities that may not be recognized as traditional sources of health information.

16.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816932

ABSTRACT

Background: Food insecurity can negatively impact adherence to and receipt of high-quality cancer care. The purpose of the study was to (1) compare the prevalence of COVID-19 associated food insecurity among cancer survivors to adults without a history of cancer and (2) examine determinants associated with COVID-19 related food insecurity among cancer survivors. Methods: We used nationally-representative data from the COVID-19 Household Impact Survey (n = 10,760), collected at three time points: April 20-26, May 4-10, and May 30-June 8 of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). Primary outcomes of food insecurity were categorized on how often (response options: often true, sometimes true, never true) participants reported the following: “We worried our food would run out before we got money to buy more” or “The food that we bought just didn't last, and we didn't have money to get more”;respondents were categorized as food insecure if they chose often true or sometimes true. We also examined use of food pantry assistance or Supplemental Nutrition Assistance Program benefits during the pandemic period;respondents were also categorized as food insecure if they received or applied for these benefits. We compared reported food insecurity among cancer survivors to other U.S. adults using Chi-square tests. Multivariable Poisson regression was used to identify demographic determinants of food insecurity among cancer survivors. Results: Thirty-two percent of cancer survivors were food insecure. Cancer survivors aged 30-44 years and those aged ≥60 were more likely to report being food insecure compared to respondents without a history of cancer in the same age categories (30-44 years, 59.9% versus 41.2% p = 0.01, ≥60 years 27.2% versus 20.2%, p = 0.01). Cancer survivors without a high school diploma were more likely to report food insecurity compared to adults without a high school diploma and no history of cancer (87.0% versus 64.1%, p = 0.001). In examining determinants of food insecurity among cancer survivors, adults aged 45-49 years when compared to those ages ≥60 (aPR = 1.54, 95% CI 1.16-2.03), adults with no high school diploma (aPR = 2.63, 95% CI 1.53-4.50) or a high school degree (aPR = 1.94, 95% CI 1.08-3.49) compared to those with a baccalaureate or above, adults with an annual household income <$30,000 (aPR: 2.16, 95% CI: 1.15-4.07) compared to those earning ≥$100,000, and cancer survivors in rural areas (aPR = 1.51, 95% CI 1.07-2.12) compared those living in urban areas were more likely to report being food insecure. Uninsured cancer survivors (aPR: 2.39, 95% CI: 1.46-3.92) and those on Medicaid (aPR: 2.10, 95% CI: 1.40-3.17) were more likely to report being food insecure than their counterparts. Conclusions: Food insecurity during the COVID-19 pandemic is vast but varies considerably among cancer survivors and adults without a history of cancer. Among cancer survivors, differences in food insecurity were observed by age, SES, and area of residence.

17.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816930

ABSTRACT

Background: Cancer survivors often experience financial hardship due to high costs associated with cancer treatment. Our objective was to (1) identify determinants of financial hardship, and to (2) evaluate the impact of financial hardship on mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods: We used nationally representative data from the COVID-19 Household Impact Survey collected at three-time points: April 20-26, May 4-10, and May 30th -June 8 th of 2020. Our primary exposure was cancer survivor status, based on participant's self-report of a cancer diagnosis (n=854, 7.1%). We defined financial hardship using the following question: “Suppose you have an unexpected expense that costs $400. Based on your current financial situation, how would you pay for this expense?” Respondents were categorized as experiencing financial hardship if they chose the following options: I wouldn't be able to pay for it right now;sell something;use a payday loan, deposit advance, or overdraft;borrow from a friend or family member. Chi-square (χ2 ) tests were used to compare reported financial hardship among cancer survivors to other U.S. adults. Multivariable Poisson regression was used to identify determinants of financial hardship among cancer survivors. We used multinomial logistic regression to evaluate associations of financial hardship on mental health symptoms of cancer survivors. Results: Eighteen percent of cancer survivors reported experiencing financial hardship. Cancer survivors aged 30-44 (44.8%) and 45-59 years (25.9%) more frequently reported financial hardship compared to adults without cancer (23.4%, 16.7%, respectively, χ2p<0.05). Compared to cancer survivors aged 60+ years, those aged 18-29 (aPR: 2.54, 95% CI;1.51-4.28), 30-44 (aPR:3.41, 95% CI:2.26-5.16), and 45-59 years (aPR:3.66, 95% CI:2.26-5.16) were more likely to experience financial hardship. Cancer survivors on Medicaid (aPR: 1.76, 95% CI: 1.16-2.66) were more likely to experience financial hardship compared to their counterparts. Compared to those without a high school degree, cancer survivors with some college education (aPR: 0.30, 95% CI: 0.18-0.47) and with a ≥Baccalaureate degree (aPR:0.05, 95% CI: 0.02- 0.14) were less likely to experience financial hardship. Rural cancer survivors had 61% higher prevalence of financial hardship compared to urban residents (aPR: 1.61, 95% CI:1.00-2.58), however, suburban residents were less likely to experience financial hardship compared to cancer survivors living in urban areas (aPR: 0.65, 95% CI:0.44-0.98). Cancer survivors who experienced financial hardship were more likely to report feeling depressed (aOR: 2.78, 95% CI: 1.39-5.56), lonely (aOR: 3.06, 95% CI: 1.39-6.72), and hopeless (aOR: 3.16, 95% CI: 1.36-7.37) 3-7 days during the last 7 days. Conclusion: Lower SES measures and younger age were determinants of experiencing financial hardship among cancer survivors. During the COVID-19 pandemic, there is a high burden of mental health symptoms among cancer survivors experiencing financial hardship.

18.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816908

ABSTRACT

Background and Purpose: Until a vaccine is widely available, adherence to COVID-19 preventive behaviors is the most effective way to prevent the spread of the COVID-19 pandemic. While there is a general paucity of information on COVID-19 infection and its impact on cancer patients, immunocompromised individuals, such as cancer patients, are likely at greater risk for both COVID-19 morbidity and mortality. In addition, a cancer diagnosis can cause stress, anxiety, depression, psychological distress, and poor quality of life. While the recommendations for COVID-19 parallel the common recommendations for managing infection risk, the enhanced social isolation and limited social distancing can be even more difficult for patients resulting in increased risk for psychological distress and deteriorations in health outcomes. Depressive disorders frequently result in substantial functional impairment, as well as increased emotional, economic, and productivity costs. It is important to understand how the COVID-19 pandemic impacts psychological and psychosocial factors, as well as health behaviors of cancer patients and survivors, and how various contextual factors may play risk and protective roles. The purpose of this study, therefore, is to determine differences in stress, mental health and coping behaviors, and adherence to COVID-19 preventive behaviors during the COVID-19 pandemic among three groups of adults (in active cancer treatment, cancer survivors, and those without a history of cancer). This study focuses on determining how sociodemographic characteristics and cancer status influence COVID-19 mental health/coping mechanisms, as well as how mental health/coping mechanisms and cancer status may predict adherence to preventive COVID-19 behaviors. Methods: Panel survey firm Qualtrics was used to administer an online survey among 897 U.S. adults in May of 2020. Quota sampling was utilized to ensure a sample consisting of approximately one-third: cancer patients currently in treatment (32.0%, n = 287), cancer survivors not currently in treatment (33.6%, n=301), and respondents with no cancer history (34.4%, n = 309). Survey items assessed demographic variables, depression, coping, and adherence to COVID-19 preventive behaviors. Results and Discussion: Preliminary analyses show that cancer patients report higher levels of depressive symptoms than survivors and the control group. In addition, cancer patients in active treatment use both avoidance and approach-focused coping more frequently than both survivors and the control group. Regression analyses show that avoidance coping predicts lower adherence to COVID-19 preventive behaviors, while approach-focused coping predicts higher adherence. Analyses are ongoing.

19.
Clinical Cancer Research ; 27(6 SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1816905

ABSTRACT

Purpose: To determine patterns of and factors associated with COVID-19-related preventive behaviors practiced by cancer survivors. Methods: Participants (N=897) were recruited through a commercial survey administration and sampling company, Qualtrics, in June 2020. Quota sampling was utilized to ensure the sample would consist of approximately one-third of cancer patients currently in treatment, one-third of cancer survivors not currently in treatment, and one-third of individuals without a history of cancer. Survey items collected information on socio-demographic characteristics (age, gender, race, and education attainment) and COVID-19-related preventive behaviors in the past week. Eight items focused on handwashing, avoiding contact with sick people, staying home when feeling sick, respiratory hygiene, avoiding touching face, social distancing, avoiding large gatherings, and wearing a mask were reported on a 4-point Likert scale (never to frequently). Differences between groups were assessed using one-way ANOVAs with Tukey post hoc tests. Results: Respondents were 49.6 years (SD=17.3) on average, 51.6% female, and 48.9% had a Bachelor's degree or higher education attainment. Most respondents were White (66.7%), with 16.8% Black and 16.5% Hispanic participants. Those with no history of cancer were more likely to avoid someone ill (p<.01) and stay home when sick (p<.001) than cancer survivors not currently in treatment. However, survivors were less likely to stay home when sick than cancer patients in treatment (p=001) and less likely to avoid touching their face (p<.05) than those with no cancer history. Analyses are ongoing and will explore factors related to COVID-19 preventive behaviors within each group. Conclusions: There are differences in COVID-19-related preventive behaviors by cancer status. Future research should examine the factors underlying these differences and adapt prevention efforts using this information.

20.
Clin Oncol (R Coll Radiol) ; 34(8): 508-513, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1814269

ABSTRACT

Advances in cancer treatment with resultant dramatic improvements in long-term survival have led to increasing awareness of the wide range of medical and social issues faced by survivors of malignancy. The potential deleterious effects on fertility are a significant worry of women and trans gender men, and the rising trend in delaying childbearing and the higher proportion of patients who have not completed their family at the time of diagnosis increases the demand for an optimised fertility-preservation service. Fertility preservation for this group following a diagnosis of cancer is a rapidly expanding area of reproductive medicine, although provision for such treatment often varies by region. In the past, there were few treatment options, but with dramatic improvements in oocyte cryopreservation and, more recently, ovarian tissue cryopreservation, this area of fertility care has broadened substantially. This review will be exploring areas that apply to all cisgender women, but not necessarily all trans men and non-binary individuals. There are specific considerations in fertility preservation for trans people, which are beyond the scope of this paper. All individuals with female reproductive organs should be offered the opportunity to discuss fertility preservation prior to starting potential gonadotoxic treatment. Failure to do this may negatively influence their anticancer treatment choices and adherence to treatment regimens. There are currently few networks streamlined around offering this service and as demand for these treatment options increases, it is recognised that these complex patients require specialist management within recognised care pathways. Here we are looking to describe some of the unique challenges associated with providing a state-of-the-art service, particularly in a financially unpredictable climate in the midst of the COVID-19 pandemic.


Subject(s)
COVID-19 , Fertility Preservation , Neoplasms , Cryopreservation , Female , Humans , Neoplasms/complications , Neoplasms/therapy , Pandemics
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