Examining the association among fear of COVID‐19, psychological distress, and delays in cancer care

Abstract

Background: Given the high risk of COVID-19 mortality, patients with cancer may be vulnerable to fear of COVID-19, adverse psychological outcomes, and health care delays.Methods: This longitudinal study surveyed the pandemic's impact on patients with cancer (N= 1529) receiving Patient Advocate Foundation services during early and later pandemic. Generalized estimating equation with repeated measures was conducted to assess the effect of COVID-19 on psychological distress. Logistic regression with repeated measures was used to assess the effect of COVID-19 on any delays in accessing health care (e.g., specialty care doctors, laboratory, or diagnostic testing, etc.).Results: Among 1199 respondents, 94% considered themselves high risk for COVID-19. Respondents with more fear of COVID-19 had a higher mean psychological distress score (10.21; 95% confidence intervals [CI] 9.38-11.03) compared to respondents with less fear (7.55; 95% CI 6.75-8.36). Additionally, 47% reported delaying care. Respondents with more fear of COVID-19 had higher percentages of delayed care than those with less (56; 95% CI 39%-72% vs. 44%; 95% CI 28%-61%). These relationships persisted throughout the pandemic. For respondents with a COVID-19 diagnosis in their household (n = 116), distress scores were similar despite higher delays in care (58% vs. 27%) than those without COVID-19.Conclusions: Fear of COVID-19 is linked to psychological distress and delays in care among patients with cancer. Furthermore, those who are personally impacted see exacerbated cancer care delays. Timely psychosocial support and health care coordination are critical to meet increased care needs of patients with cancer during the COVID-19 pandemic.

Patients’ Experiences with Cancer Care: Impact of the COVID-19 Pandemic

“…Only about one-quarter of survey respondents reported coping very well during the pandemic with worse coping across several sociodemographic groups. Several other studies assessed the psychosocial impact of the COVID-19 pandemic on cancer patients, such as fear and social isolation, but not overall coping ( 4 , 8 , 10 , 42 ). For example, Lou and colleagues’ ( 4 ) cross-sectional survey found significantly higher levels of concern about contracting COVID-19, serious illness, and not being able to get needed healthcare (for COVID-19 or other serious illness) among respondents with cancer.…”

Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study

“…Telemedicine can also facilitate remote symptom management, chemotherapeutic supervision, palliative care, and psychological support [4][5][6]. As the SARS-CoV-2 (COVID-19) pandemic spread across the globe, patients with cancer suffered compromised care, including delays in treatment, cancer screening tests [7], and referrals to specialists [8], because of concerns about treatment-related complications and facility-based exposure to COVID-19 [9,10]. To circumvent the crisis, telemedicine use was recommended to limit the risk of facility-based viral transmission, protect patients with chronic diseases who require ongoing medical treatment, and conserve personal protective equipment [11].…”

The impact of COVID‐19 on cancer care of outpatients with low socioeconomic status

“…Recent studies indicate that people with low SES tend to have more fear of COVID‐19, 12 and that an elevated fear of COVID‐19 is linked to delays in care among patients with cancer. 13 The decline of people with low SES in our outpatient center may therefore also be associated with a decline in cancer screening and diagnosis in this population. This would also suggest that people with low SES are underutilizing health services during the pandemic compared to people with high SES.…”