Psychosocial aspects in relation to clinica status of breast cancer patients after prolonged COVID pandemic in south India: A observational survey study

ABSTRACT

Background: The prolonged global threat imposed by covid 19 pandemic's first and second wave has created immense stress among the breast cancer due to interruptions of standard oncological care. The frequent lockdown imposed had tremendous impact on the patients' financial status and posed hinderance in transportation to oncological centre. In our hospital, majority of the treatment population are from distant places and below poverty line. We conducted a questionnaire based study to assess the psychological impact in this situation affecting their quality of life(QOL) and their perspective in this current situation. MATERIALS AND METHODS:Breast cancer patients who had been diagnosed and registered in our department from 1st January to 1stApril 2020 before the covid out break were tracked from the medical records. The patients details, disease status dates of follow up and the treatment details were collected.Defaulted patients were contacted.Post one year, in April 2021, these patients were assessed clinically and questioned regarding the treatment perspective. Psychological status and health related quality of life were analysed with GAD-7 (Generalised anxiety disorder questionnaire), PHQ-9 (patient health questionnaire) and EORTC QLQ-C30 questionnaire. Results:A total of 202 breast cancer patients were included. 83 patients(41%) were diagnosed with early breast cancer of which 67(33%) patients were started on Sadjuvant chemotherapy after surgery, 16 (8%)were registered for hormonal therapy. 54(27%) patients with locally advanced, were on neoadjuvant chemotherapy. 65(32%)had metastatic disease at presentation. 23 of 65 metastatic patients were in visceral crisis and were on supportive management for the same. 35 patients had been started on palliative chemotherapy. Out of the 156 patients who had been in initiated with various chemotherapy, only 62(31%) patients were able to review at correct interval for the scheduled chemotherapy. 45 patients(22%) reviewed in the day care irregularly. Among the 45, 28 patients had locally advanced breast cancer and 22 patients had clinical progression due to prolonged gap. 38 patients(19%) had defaulted completely.Of the 38, 16 had advanced disease and presented with clinical progression of disease and switched to second line chemotherapy. 15 patients progressed to have distant metastases and are started on palliative chemotherapy or supportive care. 7 patients who were on adjuvant chemotherapy are kept under close follow up. 11 patients with metastatic breast cancer had died during the past one year. 3 patients had committed suicide.112(55 %) patients were within the city. 71 patients(35%) were from suburban areas. 19 patients(10%) were from adjacent rural areas. 113(56%) were educated.176 (87 %) were desperate to continue treatment inspite of pandemic, while remaining patients main concern was to avoid infection than to get oncological management. While the most common reason for defaulting was travel restrictions, few also documented financial issues and ignorance about progression of cancer. 46 (22%)of patients who had been visiting the day care had turned covid positive. Except for 2 patients who succumbed to the infection, none had major complications. 51%, 42%, 7% had mild, moderate and severe anxiety. 69%, 25%, 6% had mild, moderate and severe depression. The severe anxiety and depression was significant with metastatic breast cancer and educated patients. There were 3 suicides. The overall heath score had a mean of 4. The overall QOL had a mean score of 3 (1-very poor to 7-excellent). CONCLUSION: In patients who were already psychologically affected by onset of cancer, the chaos created by the pandemic added to it further. Hence the patients also need counseling appropriately during oncological treatment.