Increased Use of Porch or Backyard Nature during COVID-19 Associated with Lower Stress and Better Symptom Experience among Breast Cancer Patients

Abstract

Contact with nature has been used to promote both physical and mental health, and is increasingly used among cancer patients. However, the COVID-19 pandemic created new challenges in both access to nature in public spaces and in cancer care. The purpose of our study was to evaluate the change in active and passive use of nature, places of engaging with nature and associations of nature contact with respect to improvements to perceived stress and symptom experience among breast cancer patients during the pandemic. We conducted a cross-sectional survey of people diagnosed with breast cancer using ResearchMatch (n = 56) in July 2020 (the first wave of COVID-19). In this US-based, predominantly white, affluent, highly educated, female sample, we found that, on average, participants were first diagnosed with breast cancer at 54 years old and at stage 2 or 3. Eighteen percent of participants experienced disruptions in their cancer care due to the pandemic. As expected, activities in public places significantly decreased as well, including use of parks/trails and botanical gardens. In contrast, spending time near home, on the porch or in the backyard significantly increased. Also observed were significant increases in indoor activities involving passive nature contact, such as watching birds through a window, listening to birdsong, and smelling rain or plants. Decreased usage of parks/trails was significantly associated with higher stress (Coef = −2.30, p = 0.030) and increased usage of the backyard/porch was significantly associated with lower stress (Coef = −2.69, p = 0.032), lower symptom distress (Coef = −0.80, p = 0.063) and lower symptom severity (Coef = −0.52, p = 0.009). The most commonly reported alternatives to outdoor engagement with nature were watching nature through a window (84%), followed by looking at images of nature (71%), and listening to nature through a window (66%). The least commonly enjoyed alternative was virtual reality of nature scenes (25%). While outdoor contact with nature away from home decreased, participants still found ways to experience the restorative benefits of nature in and around their home. Of special interest in planning interventions was the fact that actual or real nature was preferred over that experienced through technology. This could be an artifact of our sample, or could represent a desire to be in touch with the “real world” during a health crisis. Nature contact may represent a flexible strategy to decrease stress and improve symptom experience among patients with cancer, particularly during public health crises or disruptions to cancer care.

Natural environments, psychosocial health, and health behaviors in a crisis – A scoping review of the literature in the COVID-19 context

“…No other differences were observed. Pearson, Breeze, Reuben, and Wyatt (2021) , USA Breast cancer patients (56, 63.1 ± 10.7, 98%, 7.1% Black, 3.6% Native American, a.8% Hispanic/Latino, 88% White) July 2020 Observational, cross-sectional, quantitative, online survey Investigate associations between changes in nature use and perceived stress Nature Self-reported frequency and engagement in nature-based active and passive activities prior and during COVID-19 Stress Perceived stress scale (PSS10) Decreased usage of parks/trails was significantly associated with higher stress (B = −2.30, p = 0.030) Pearson, Horton, et al (2021) , USA Low-income adults and older adults (86, 56.8 ± 14.6, 57%, 83% African-American) August–October 2019 June–July 2020 Observational, longitudinal/cross-sectional, quantitative, online survey + geospatial analysis Investigate associations between quality of nature views from home and mental health issues Nature Objectively assessed park view from home Self-reported access and use of nature Stress Anxiety Depression Perceived stress scale (PSS10) Patient-Reported Outcomes Measurement Information System (PROMIS) Higher visibility of greenspace was associated with higher anxiety (β = 3.97, p = 0.025), but not depression or stress. Use and accessibility were unrelated to all constructs.…”

Nature exposure and mental health during the COVID-19 pandemic: A Navigation Guide systematic review with meta-analysis

“…Four studies reported perceived neighborhood greenery (Dzhambov et al, 2021;Lenaerts et al, 2021;Oswald et al, 2021;Ribeiro et al, 2021). Two studies assessed the changed use of greenspace (e.g., parks, botanical gardens, balconies) (Larson et al, 2022;Pearson et al, 2021). A cross-sectional study reported changes in nature sound during the pandemic compared to pre-pandemic time (Garrido-Cumbrera et al, 2021) as a possible nature contact indicator.…”

“…Thirteen studies (22%) reported an association between nature exposure and stress, including nine cross-sectional designs (Basu et al, 2021;Bourion-Bédès et al, 2021;Jato-Espino et al, 2022;Lõhmus et al, 2021;Mintz et al, 2021;Pearson et al, 2021;Ribeiro et al, 2021;Sansal et al, 2021;Sundara Keeren et al, 2021), two cohorts (Vos et al, 2022;Wortzel et al, 2021) and two ecological study design (Robinson et al, 2021;Yao et al, 2022) (Table 1). Of these, three studies used a 10-item perceived stress scale (PSS) (S. Cohen et al, 1983) & Bekker, 1992), one study reported 5-item interactive assessment of COVID-19 related stress, one study used mental stress index, and the remaining three studies reported self-reported 1-item question for measuring stress.…”

“…However, several studies did not find any significant impact of nature availability, such as nearby greenspace (Wortzel et al, 2021) and distance to greenspace (Robinson et al, 2021), on stress during COVID-19. Several studies found a positive association between nature contact, such as time spent in the home garden or outdoor spaces (Basu et al, 2021;Sansal et al, 2021), frequent visits to nature (Lõhmus et al, 2021), increased usage of the backyard or porch (Pearson et al, 2021), nature near home (Mintz et al, 2021), public nature space (Ribeiro et al, 2021), participating week-long nature therapy and nature-exercise program (Sundara Keeren et al, 2021) and stress reduction. However, studies reported community greenspaces (Ribeiro et al, 2021) and being in nature (Mintz et al, 2021) were not associated with stress.…”

“…Of the total, three had a high risk of bias (Sansal et al, 2021;Sundara Keeren et al, 2021;Yao et al, 2022), six had probably high risk of bias (Basu et al, 2021;Jato-Espino et al, 2022;Lõhmus et al, 2021;Robinson et al, 2021;Vos et al, 2022;Wortzel et al, 2021) and the remaining four showed a low risk of bias (Bourion-Bédès et al, 2021a;Mintz et al, 2021;Pearson et al, 2021;Ribeiro et al, 2021) (Table S2 & Table S3). Quality of evidence was "very low" due to the high amount of high to probably high risk of bias studies and high inconsistency of effect measures (supplementary material S3, Table S4).…”