It's poverty - not the pandemic: the impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

ABSTRACT

BackgroundThe COVID-19 pandemic has affected psychological wellbeing in many aspects, but its influence on cancer patients it not yet clear, and studies show mixed results. AimsWe aimed to investigate the impact of the pandemic on psychological symptom burden against the socio-economic background of cancer patients using data from routine assessments before and during the pandemic. MethodsStandardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with separate ANOVAs and Bonferroni pairwise comparisons as post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic risk factors. All tests were two-sided. ResultsOnce indicators of socioeconomic status were included in the analysis, the seeming influence of the pandemic became negligible. Only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial {eta}2 = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress. ConclusionsAlthough the pandemic is a major stressor in many respects, poverty is by far the most important risk factor for psychological symptom burden in cancer outpatients and outweighs the impact of the pandemic.