Do COVID-19–Related Treatment Changes Influence Fear of Cancer Recurrence, Anxiety, and Depression in Breast Cancer Patients?

Abstract

BackgroundThe worldwide spread of the coronavirus disease 2019 (COVID-19) has impacted the treatment of cancer patients. Treatment changes can negatively affect patients’ prognosis and may be psychologically burdensome.ObjectiveThe aim of this study was to explore whether COVID-19–related treatment changes (delays, cancellations, changes) influenced fear of cancer recurrence, anxiety, and depression in breast cancer patients.MethodsA convenience sample (n = 154) of patients who were diagnosed with breast cancer no longer than 2 years ago was obtained from an online community and social network site. The survey content included COVID-19–related treatment experiences and psychological status. The data were analyzed using descriptive statistics, χ2 test, independent t test, and analysis of variance.ResultsTwenty-nine patients (18.8%) had experienced COVID-19–related treatment changes, and changes of the treatment plan had a significant correlation with depression (t = 2.000, P = .047). Fear of cancer recurrence was high (mean score, 84.31 ± 24.23). Fifteen percent had moderate to severe levels of anxiety, and 24.7% had moderate to severe levels of depression. Narrative reports also identified COVID-19–related unforeseen costs.ConclusionIn the midst of the COVID-19 pandemic, breast cancer patients experienced treatment changes, and changes in treatment plans were significantly associated with depression. Fear of recurrence, anxiety, and depression were found at high levels.Implications for PracticeOncology nurses should assess the psychological status of cancer patients in the early survivorship phase who appear to be especially vulnerable during the COVID-19 pandemic. Oncology nurses can also monitor whether patients are receiving timely supportive care to alleviate fears and anxiety and assess financial needs for COVID-19–related costs.

On top of that all, now Covid-19, too. A scoping review of specificities and correlates of fear of cancer recurrence in breast cancer patients during COVID-19

“…Furthermore, 35.7% of the participants assessed in this study attained severity scores higher than 22, suggesting that over one third of the participants experienced a clinically significant level of fear of cancer recurrence. This result was compared with the results obtained on similar populations, assessed with the same instrument in non-Covid-19 periods, and the results indicated that the number of the participants assessed in the Kim and Kim's [ 48 ] study, who reported clinically significant values of FCR (meaning 22 points) was twice as high. However, as the authors have emphasized, these differences have to be interpreted with caution because the previous study to which they compared their results involved older participants, the period of time between diagnosis and assessment was longer, and was conducted before the pandemic.…”

“…However, as the authors have emphasized, these differences have to be interpreted with caution because the previous study to which they compared their results involved older participants, the period of time between diagnosis and assessment was longer, and was conducted before the pandemic. According to this study, FCR was significantly higher among participants that were not married (F = 3.649, p = .028 ), childless (t = −2.043, p = .043 ) less financially potent participants (F = 4.259, p = .016 ) [ 48 ].…”

“… No. Study, country Study design Sample size, Cancer type Measures of FCR Other variables usually associated with greater FCR, also measured in the study Results Limitations of the study 1 [ 48 ] South Korea April–June 2020 Descriptive correlational Cross-sectional Quantitative Qualitative N = 154 Breast cancer survivors Instruments Fear of Cancer Recurrence Inventory (K-FCRI) subscales: triggers severity psychological distress coping strategies functional impairments insight reassurance validated instrument Age Marital status Nr of children Nr of children living together Ages of children living together Level of education Monthly income Economic burden Area of residence Timing of diagnosis Treatment type Time required to visit medical institutions Experience of quarantine due to Covid-19 suspicion Whether diagnosed with Covid-19 FCR high (84.31 ± 24.23) Triggers (21.30 ± 6.50) Coping strategies (20.58 ± 6.09) Severity Demographic variables FCR significantly higher among unmarried (F = 3.649, P-.028) Without children (t = −2.043, P = .043) Radiotherapy (t = 2.790, P = .006) Monthly income (F = 4.259, P = .016) Convenience sample, Online assessment Selection bias Restricted access to rural areas South Korea – high quality of health insurance and medical infrastructure Did not exclude patients with psychiatric diagnoses No investigation on categories of FCR Not controlling of variables that could have affected psychological status 2 [ 33 ] Turkey 10–20 May 2020 Descriptive cross-sectional online survey N = 82 female, non-metastatic breast cancer survivors Instruments Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF)– Turkish validated form 12-item Spiritual well-being (SWB) scale (Peterman et al, 2002) – adapted to Turkish 6-item brief resilience scale (BRS) (Smith et al, 2008) – Turkish validated form Demographic variables: - marital status - age Smoker-non-smoker - income 84.1% of the participants experienced high levels of FCR ...…”

“… Kim and Kim's [ 48 ] investigation included 154 breast cancer patients, using both quantitative and qualitative methods. Fear of cancer recurrence was measured with the Korean version of the Fear of Cancer Recurrence Inventory (K-FCRI).…”

“…FCR global scores were used to offer a complete picture of the fear of cancer recurrence, while the FCR severity sub-score was used to investigate participants' clinical status. Regarding the severity sub-factor of FCR, scores ranging between 0 and 15 indicated minimal levels of FCR, between 16 and 23 problematic levels, and scores over 22 indicated clinically significant levels of FCR due to the changes in the treatment plan during the Covid-19 pandemic [ 48 ].…”