Cancer survivors' cancellations of healthcare appointments during the COVID‐19 pandemic: Associations with anxiety and depression

Abstract

Objective: Though it is well-documented that cancer survivors experienced healthcare delays during the COVID-19 pandemic, who initiated those delays has not been examined. This longitudinal study distinguishes rates of patient-from provider-cancelled healthcare appointments at three timepoints during the pandemic, and examines psychosocial factors associated with patient-cancelled appointments.Methods: Cancer survivors (N = 147) in the United States completed psychosocial and health behavior measures three times between May and December 2020. We examined rates of patient-and provider-cancelled healthcare appointments, including cancer screening appointments, at each timepoint and change between timepoints. Logistic regression was used to determine if anxiety symptoms, depression symptoms, and COVID-19 fears were associated with self-cancelled healthcare appointments. Results:In May 2020, one third (33.79%) of participants reported one or more selfcancelled appointments within the prior 2 months and nearly half (45.89%) reported one or more provider-cancelled appointments. Rates of provider-cancelled appointments decreased to 35.71% in June/July 2020 and to 9.24% in November/ December 2020 (both reflected p < 0.05 reductions compared to the previous timepoint). Rates of self-cancelled appointments, however, remained more stable (ps > 0.144). In June/July and November/December 2020, higher depression and anxiety symptoms, but not COVID-19 fears, were associated with greater likelihood of self-cancelled appointments.Conclusions: Cancer survivors cancelled their healthcare appointments at a stable rate even as provider-cancelled appointments declined. Depression and anxiety symptoms, but not COVID-19 concerns, were associated with patient cancellations.Interventions that address anxiety and depression symptoms may help to promote adherence to cancer survivorship care during the pandemic.

Disruptions in Cancer Care Due to the COVID-19 Pandemic and Fear of Cancer Recurrence in Women with Breast Cancer: A Mixed-Methods Study

“…During the pandemic, a decrease in diagnostic mammograms [5,6] and cancer surgeries [7] has been documented. A study conducted in the United States among cancer survivors (n = 147) indicated that, in May 2020, 45.9% of the participants reported at least one provider-cancelled appointment [8]. Similarly, Papautsy and Hamish (2020) found that 44% of breast cancer survivors reported delays or changes in their cancer care trajectory (e.g., breast cancer surgery, diagnostic imaging and laboratory testing, anti-cancer therapies, and follow-up appointments).…”

Nativity differences in socioeconomic barriers and healthcare delays among cancer survivors in the All of Us cohort

“…However, physical health is not the only aspect affected; mental health may also suffer at the hands of delayed care [ 8 ]. For instance, COVID-19 led to numerous appointment cancelations for cancer survivor patients, including self-cancelations that were caused by depression and anxiety symptoms surrounding the pandemic and safe access to care [ 9 ]. These missed appointments, in turn, exacerbated patients’ fears of cancer recurrence as their follow-up care were halted (e.g., laboratory testing, imaging, and appointments), impacting their overall well-being and physical and mental health [ 10 , 11 ].…”