A Systematic Review of the Impact of Covid- 19 on Cancer Patients and Survivors from an Economic, Social and Psychological Perspective

ABSTRACT

Background: Cancer is one of the leading causes of death and has been found to have a significant associated economic burden. That cancer diagnosis comes with a financial burden on patients and survivors is known but little is known about the psychological and social impact of COVID-19 or how the resulting economic environment has exasperated this further. Aims of the Study This systematic review examines the impact of COVID-19 on cancer patients and survivors from an economic, social and psychological perspective. Methods: A systematic review of the literature published between January 2020 and March 2021 was completed by searching electronic databases. The review protocol was registered on the PROSPERO database. Results were analysed using a thematic analysis approach. Results: A total of 55 articles were identified. Approximately 93% of the psychological studies reviewed reported increased anxiety, depression, psychological distress and worry in cancer patients. Evidence in 50% of social studies reviewed, showed that national stayat- home guidelines compounded and contributed to feelings of increased loneliness and social isolation. While the underlying economic conditions were found to impact health systems both positively and negatively with reports of a modified workflow and transitioning to telemedicine. Discussion and Limitations: National stay-at-home guidelines implemented to stop the spread of the virus and protect vulnerable populations were found to have a negative social effect on patients. Increased anxiety, depression, psychological distress and worry among cancer patients was found. Furthermore, there is evidence of socio-economic inequalities with certain subgroups more vulnerable to the economic strain caused by Covid-19 than others. Psychological strain and financial distress are side effects associated with cancer treatment but COVID-19 exasperated these side effects further. Many of the papers reviewed were reliant on single institutions and lack long term follow-up and in some cases data were only available for short periods which had negative implications on sample size. Implications for Healthcare Provision and Use COVID-19 has reduced healthcare capacity, adversely impacting delivery and access to healthcare and causing a re-distribution of resources to meet with demand. In addition environmental considerations such as national and institutional COVID-19 guidelines and the reaction/ behaviour of patients to these guidelines will influence both demand and supply behaviour. The underlying economic conditions were found to impact health systems both positively and negatively with reports of a modified workflow and transitioning to telemedicine. Implications for Health Policy The results provide reflections on how care for cancer patients undergoing treatment were affected by the pandemic. This informs continued plans for the implementation of the National Cancer Strategy and operationalisation plans for Ireland's blueprint for universal health care, Sláintecare. Implications for Future Research Before COVID-19, studies were already shown to be lacking particularly on the financial burden of cancer on patients. The need for more studies in this area is paramount in order to fully understand the challenges that cancer patients face particularly because of COVID. The systematic review revealed few papers on survivors (two years post treatment)of cancer. The late effects of cancer and its treatment are well documented and extend further than active treatment and with only a few studies reporting on the psychological effects the true impact and risk to survivors is not yet fully understood.