The emotional impact of COVID-19 outbreak on cancer out-patients and their caregivers: Impressions from the heart of the Italian pandemic

ABSTRACT

Background: During COVID-19 pandemic, cancer patients (pts) have to be protected because of higher morbidity and mortality risk. While follow up visits were rescheduled, frequently treatments couldn’t be delayed without compromising efficacy. The aim of this study is to investigate the emotional discomfort of out-patients and their caregivers (CG), who needed access to hospitals to receive cancer treatment during the pandemic. Methods: This is a single-institutional experience of the Department of Oncology at L. Sacco Hospital, one of the Italian hospitals most affected by COVID-19 pandemic. From 5 to 15 May 2020 we conducted a survey on out-patients in active cancer therapy and their CG. We created two different multiple-choice questionnaires (15 questions for pts, 17 for CG) looking at demographic characteristics and changes in emotional status, interpersonal relationships with health professionals (HCPs) and self-perception of treatment outcomes. The answers could be yes, enough vs no, I don't know. Results: Questionnaires from 332 pts and 117 CG were examined. 65.1% pts and 53% CG were female;65.7% of pts were >60 ys old and 55.6% of CG were between 41-60 ys. 48.7% of pts vs only 27.4% CG thought to be at greater risk of infection because of living together or visiting the hospital. Both pts and CG considered containment measures (triage at hospital entrance, social distancing, personal protective equipment) as valid support to avoid the spread of infection (87% vs 82%, respectively) without excessive loss of time (79.8% vs 86.3%). Waiting and performing visits and treatments without CG had no impact on emotional status of pts (67.3%), but generated greater anxiety in CG (59.7%) and fear of poor patient management at home (17.7%). The majority of pts (52.6%) and CG (37.6%) did not think that the pandemic influenced treatment outcome. Relationships with HCPs was not negatively affected for 75% pts and 51% CG. Conclusions: The majority of pts believed they had a higher risk of COVID-19 infection and therefore approved the application of safety standards to help them feel more protected. Good relationships with HCPs contributed to receive face-to-face treatments without experiencing additional distress. For CG the main issues were limitations in sharing of pts' care routines and the perceived impairment in relationships with HCPs. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure N.M. La Verde Honoraria (self) Eisai;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses Roche;Gentili;Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses Pfizer;Advisory/Consultancy Novartis, Celgene, MSD. All other authors have declared no conflicts of interest.