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1.
Int J Environ Res Public Health ; 19(6)2022 03 08.
Article in English | MEDLINE | ID: covidwho-1732044

ABSTRACT

The COVID-19 outbreak, which was followed by home confinement, is expected to have had profound negative impact on the mental health of people. Associated factors, such as losing jobs and income, can be expected to lead to an increased risk of suffering from psychopathological problems. Therefore, this study was aimed at researching the associations of job and income loss with mental health, as well as the possible mediating role of perceived financial stress during the COVID-19 outbreak. The sample included 2381 Spanish workers who were interviewed right after the first COVID-19 lockdown. Measures were taken for generalized anxiety disorder, panic attacks, depression, post-traumatic stress disorder, substance abuse, suicidal thoughts and behaviors, working conditions, sociodemographic variables, and perceived financial stress. Logistic regression models were calculated with psychological variables as outcomes, and with job loss and income loss as predictors. Mediation analyses were performed by adding the financial threat as a mediator. Nineteen point six percent and 33.9% of participants reported having lost their jobs and incomes due to the pandemic, respectively. Only income loss was related to a higher risk of suffering from depression and panic attacks. When adding financial stress as a mediator, the indirect effects of job and income loss on the mental health measures were found to be significant, therefore indicating mediation. These findings pinpoint the vulnerability of this population, and highlight the need for interventional and preventive programs targeting mental health in economic crisis scenarios, such as the current one. They also highlight the importance of implementing social and income policies during the COVID-19 pandemic to prevent mental health problems.


Subject(s)
COVID-19 , COVID-19/epidemiology , Communicable Disease Control , Financial Stress/epidemiology , Humans , Mental Health , Pandemics , Stress, Psychological/epidemiology , Stress, Psychological/etiology
2.
Cancer ; 127(21): 4072-4080, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1320064

ABSTRACT

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues to spread, it remains unclear how vulnerable populations with preexisting health conditions like cancer have been affected. METHODS: Between July and September of 2020, the authors conducted a cross-sectional study that surveyed 2661 patients with breast cancer who were registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort and received 1300 responses (71.5% White patients and 22.4% Black patients). The survey measured the psychosocial well-being of participants before and during the COVID-19 pandemic and examined whether they experienced any type of financial challenges or treatment disruption. RESULTS: The results indicated that feelings of isolation increased significantly during the pandemic. Meanwhile, the overall median isolation/stress score was 1.2 on a scale from 0 (never) to 4 (always), which was not significantly different between White patients and Black patients. One-third of patients experienced some type of financial challenge during this time. Medicaid recipients, of whom almost 80% were Black, were more likely to experience financial challenges. In addition, approximately one-fourth of patients experienced difficulty getting treatment. CONCLUSIONS: This study indicates that the quality of life of patients with breast cancer and their scheduled treatments have been adversely affected during the COVID-19 pandemic. These findings suggest that more support should be provided by hospital centers and the medical research community to patients with cancer during this challenging pandemic. LAY SUMMARY: The authors surveyed patients with breast cancer in Chicago using a questionnaire to examine how their lives have been affected during the coronavirus disease 2019 (COVID-19) pandemic. The results indicate that the lives of patients with breast cancer and their scheduled treatments have been adversely affected during the pandemic. In addition, patients who were covered by Medicaid, most of whom were Black, were more likely to experience financial challenges. The findings suggest that hospital centers and the medical research community should reach out and provide more information to support patients with cancer during this challenging pandemic.


Subject(s)
Breast Neoplasms/therapy , COVID-19/epidemiology , Pandemics , Quality of Life , Withholding Treatment , Aged , /statistics & numerical data , Breast Neoplasms/ethnology , Chicago/epidemiology , Chicago/ethnology , Cross-Sectional Studies , Female , Financial Stress/epidemiology , Financial Stress/ethnology , Health Services Accessibility/statistics & numerical data , Health Surveys/statistics & numerical data , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Humans , Medicare/statistics & numerical data , Middle Aged , Patient Reported Outcome Measures , Prevalence , Social Isolation/psychology , United States , /statistics & numerical data
3.
Cancer ; 127(14): 2399-2408, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1287332

ABSTRACT

BACKGROUND: New York City (NYC) emerged as an epicenter of the COVID-19 pandemic, and marginalized populations were affected at disproportionate rates. The authors sought to determine the impact of COVID-19 on cancer treatment, anxiety, and financial distress among low-income patients with gynecologic cancer during the peak of the NYC pandemic. METHODS: Medicaid-insured women who were receiving gynecologic oncology care at 2 affiliated centers were contacted by telephone interviews between March 15 and April 15, 2020. Demographics and clinical characteristics were obtained through self-report and retrospective chart review. Financial toxicity, anxiety, and cancer worry were assessed using modified, validated surveys. RESULTS: In total, 100 patients completed the telephone interview. The median age was 60 years (range, 19-86 years), and 71% had an annual income <$40,000. A change in employment status and early stage cancer (stage I and II) were associated with an increase in financial distress (P < .001 and P = .008, respectively). Early stage cancer and telehealth participation were significantly associated with increased worry about future finances (P = .017 and P = .04, respectively). Lower annual income (<$40,000) was associated with increased cancer worry and anxiety compared with higher annual income (>$40,000; P = .036 and P = .017, respectively). When controlling for telehealth participation, income, primary language, and residence in a high COVID-19 prevalence area, a delay in medical care resulted in a 4-fold increased rate of anxiety (P = .023, 95% CI, 1.278-14.50). Race was not significantly associated with increased financial distress, cancer worry, or anxiety. CONCLUSIONS: Low socioeconomic status was the most common risk factor for increased financial distress, cancer worry, and anxiety. Interventions aimed at improving access to timely oncology care should be implemented during this ongoing pandemic.


Subject(s)
COVID-19/psychology , Financial Stress/epidemiology , Genital Neoplasms, Female/therapy , Pandemics/economics , Adult , Aged , Aged, 80 and over , COVID-19/economics , Female , Financial Stress/etiology , Genital Neoplasms, Female/economics , Genital Neoplasms, Female/psychology , Humans , Medicaid , Mental Health , Middle Aged , New York City , Pilot Projects , Poverty , Surveys and Questionnaires , Telemedicine , United States , Young Adult
4.
J Clin Endocrinol Metab ; 106(7): e2469-e2479, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1247625

ABSTRACT

CONTEXT: The COVID-19 pandemic has impacted healthcare environment. OBJECTIVE: To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). DESIGN AND SETTING: Prospective longitudinal survey study at 2 tertiary centers. PARTICIPANTS: Patients with AI. INTERVENTION: Patient-centered questionnaire. MAIN OUTCOME MEASURES: Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. RESULTS: Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. CONCLUSIONS: A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.


Subject(s)
Adrenal Insufficiency/drug therapy , Anxiety/epidemiology , COVID-19/prevention & control , Patient Reported Outcome Measures , Self-Management/statistics & numerical data , Adrenal Insufficiency/economics , Adrenal Insufficiency/psychology , Age Factors , Aged , Anxiety/diagnosis , Anxiety/etiology , Anxiety/psychology , COVID-19/economics , COVID-19/epidemiology , COVID-19/psychology , Communicable Disease Control/standards , Female , Financial Stress/diagnosis , Financial Stress/epidemiology , Financial Stress/psychology , Glucocorticoids/administration & dosage , Glucocorticoids/economics , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics/economics , Pandemics/prevention & control , Patient Health Questionnaire/statistics & numerical data , Prevalence , Prospective Studies , Quality of Life , Risk Factors , Self Report/statistics & numerical data , Self-Management/economics , Sex Factors , United States/epidemiology
6.
Support Care Cancer ; 29(7): 4137-4146, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1009140

ABSTRACT

PURPOSE: Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers' emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. METHODS: We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers' emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. RESULTS: A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of "1: Much lower" to "5: Much higher", the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1-5) for financial strain, 3.61 (SD: 0.86; range: 1-5) for physical strain, and 3.88 (SD: 0.89; range: 1-5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. CONCLUSION: These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.


Subject(s)
COVID-19/epidemiology , Caregivers , Financial Stress/ethnology , Neoplasms/therapy , Pain/ethnology , Stress, Psychological/ethnology , Adult , Aged , Aged, 80 and over , Burnout, Professional/economics , Burnout, Professional/epidemiology , Burnout, Professional/ethnology , Burnout, Professional/psychology , COVID-19/psychology , Caregivers/economics , Caregivers/psychology , Caregivers/statistics & numerical data , Cross-Sectional Studies , /statistics & numerical data , Female , Financial Stress/epidemiology , Financial Stress/psychology , Humans , Male , Middle Aged , Neoplasms/economics , Neoplasms/epidemiology , Neoplasms/ethnology , Pain/economics , Pain/epidemiology , Pandemics , Psychological Distress , /statistics & numerical data , Stress, Psychological/economics , Stress, Psychological/epidemiology , Surveys and Questionnaires , United States/epidemiology , Young Adult
7.
World J Urol ; 39(7): 2559-2565, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-888173

ABSTRACT

PURPOSE: To ascertain renal cell carcinoma (RCC) financial toxicity on COVID-19 during the COVID-19 crisis as patients are struggling with therapeutic and financial implications. METHODS: An online survey was conducted from March 22 to March 25, 2020. It included baseline demographic, clinicopathologic, treatment-related information, anxiety levels related to COVID-19, questions related to financial concerns about COVID-19 as well as the validated 11-item COST measure. RESULTS: Five-hundred-and-thirty-nine patients (39%:58% male:female) from 14 countries responded. 23% of the patients did not feel in control of their financial situation but 8% reported being very satisfied with their finances. The median COST score was 21.5 (range 1-44). Metastatic patients who have not started systemic therapy had a COST score (19.8 range 2-41) versus patients on oral systemic therapy had a COST score (23.9 range 4-44). Patients in follow-up after surgery had a median COST score at 20.8 (range 1-40). A low COST scores correlated (p < 0.001) were female gender (r = 0.108), younger age (r = 0.210), urban living situation (r = 0.68), a lower educational level (r = 0.155), lower income (r = 0.165), higher anxiety about acquiring COVID-19 (r = 0.198), having metastatic disease (r = 0.073) and a higher distress score about cancer progression (r = 0.224). CONCLUSION: Our data highlight severe financial impact of COVID-19. Acknowledging financial hardship and thorough counseling of cancer patients should be part of the conversation during the pandemic. Treatment and surveillance of RCC patients might have to be adjusted to contemplate financial and medical needs.


Subject(s)
COVID-19 , Carcinoma, Renal Cell , Cost of Illness , Financial Stress/epidemiology , Kidney Neoplasms , Quality of Life , Antineoplastic Agents/economics , Antineoplastic Agents/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Carcinoma, Renal Cell/economics , Carcinoma, Renal Cell/epidemiology , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/therapy , Female , Humans , Kidney Neoplasms/economics , Kidney Neoplasms/epidemiology , Kidney Neoplasms/pathology , Kidney Neoplasms/therapy , Male , Middle Aged , Neoplasm Staging , Psycho-Oncology , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology
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