Objective The objective of this study was to assess the psychological health status of patients diagnosed with cancer in Iraq during the COVID‐19 pandemic. The study aim was to measure the prevalence of depression, anxiety, and stress among patients diagnosed with cancer. Secondary aims were to assess the association between depression, anxiety, and stress with sociodemographic characteristics, cancer‐specific characteristics, patients' experience in healthcare visit, risk perception towards COVID‐19, and health concern during the outbreak. Methods A cross‐sectional study was conducted between September 1, 2020 and December 1, 2020 at an Oncology clinic in Baghdad. Included in the study were two hundred patients diagnosed with cancer. Data collected included: demographic variables (age, gender, residential location, marital status, education, employment status), clinical characteristics and cancer‐specific parameters (duration since cancer diagnosis, cancer type, treatment duration, clinic visits frequency), experience during the pandemic (skipping or postponing treatment or periodical tests, suffering from new body pain, fear of acquiring the infection, fear of health deterioration), as well as psychological health status (depression, anxiety, stress). Pain, risk perception towards COVID‐19, and health concern were measured using categorical Likert scale with responses being no, sometimes, and often. The psychological health status was measured by the “Depression, Anxiety, and Stress Scale” (DASS‐21). Cut‐off scores of the DASS‐21 greater than 9, 7, and 14 represent a positive screen of depression, anxiety, and stress, respectively. Results The prevalence of patients who screened positive for depression was 22.0%, anxiety 22.0%, and stress 13.5%. The prevalence of depression, anxiety and stress were significantly more in those who had university or higher education (34.3%, p ‐value <0.0001; 32.3%, p ‐value <0.0001; 19.2%, p ‐value = 0.02 respectively). Those were four times more likely to have depression and two times more likely to have anxiety than participants who had school education (OR = 4.40 CI [1.98–9.77], p ‐value <0.0001; OR = 2.55 CI [1.15–5.65], p ‐value = 0.02, respectively). The prevalence of anxiety was significantly the highest in the age group 16–39 years (40.9%) compared to 22.3% in the age group 40–64 years and 10.3% in the group ≥65 years ( p ‐value = 0.02). Patients ≥65 years of age were less likely to develop anxiety compared to younger patients (OR = 0.44 CI [0.22–0.89], p ‐value = 0.02). As for the patients' experience in healthcare visit, 66 patients (33.0%) skipped or postponed their treatment or tests due to the outbreak. Around (8%) sometimes suffered from new body pain. Those who sometimes suffered from...

The COVID-19 pandemic has significantly impacted the management, treatment, and delivery of care to cancer patients. This impact has extended beyond patient care to include logistics, administration, and distribution of increasingly limited health care resources in cancer management healthcare institutions. Based on the collaborative experience of the management, administration, and medical staff at AL-Amal National Hospital (a tertiary health care institution delivering cancer management and treatment services in Baghdad, Iraq), measures were taken and recommendations were carefully formulated to safely proceed with therapy for cancer patients amid the current COVID-19 Pandemic. We hereby review and present AL-Amal National Hospital’s urgent plan to ensure that vital cancer services can still be delivered safely taking into consideration all the potential risks and benefits during this pandemic. Keywords: COVID-19; Coronavirus; SARS-CoV-2; Cancer

Introduction: Brain metastasis (BM) commonly occurs in patients with advanced lung cancer and is associated with poor prognosis and short survival periods. In some cases, select patients survive several years which is rare. Presentation of case: This case report highlights the long-term survival of a 55-year-old patient who was diagnosed with brain metastases from lung cancer three years ago and is currently alive following treatment with chemotherapy for the primary cancer and whole-brain radiation therapy and chemotherapy for the brain metastases. Since the diagnosis of brain metastases three years ago, the patient’s primary cancer has remained controlled and she is living a disease-free, functional life. Discussion: Literature review identified female gender, performance status, number of metastatic sites, the presence of a solitary lesion or single lesion, brain metastases later in their illness, adenocarcinoma histology, younger age, and patients with EGFR and ALK alterations, to be all as favorable prognostic factors associated with long term survival in patients with brain metastasis secondary to lung cancer. Conclusion: Further studies should be designed to investigate the factors that may relate to long term survival in patients with brain metastasis secondary to lung cancer. This should help further understand the treatment outcomes in these patients. Keywords: Brain Metastasis; Chemotherapy; Carboplatin; Gemcitabine; Whole-brain radiation; Non-small-cell lung cancer