Post‐traumatic stress symptomatology and adjustment of medical oncology practice during the COVID‐19 pandemic among adult patients with cancer in a day care hospital

Abstract

BACKGROUND:The COVID-19 pandemic may induce post-traumatic stress disorder (PTSD) symptoms among patients with cancer, who also face adaptations to their treatment. The authors assessed the occurrence of PTSD symptoms, investigated pandemic-induced adjustments in medical oncology practice in patients with cancer, and explored risk factors for PTSD and the association between PTSD symptoms, insomnia, and quality of life (QoL). METHODS: This prospective French study was conducted in patients with solid/hematologic tumors who were receiving medical treatment in the day care departments of 2 cancer centers during the lockdown. Adjustments to medical oncology practice were collected from medical records. PTSD (measured using the Impact of Event Scale-Revised), insomnia (measured using the Insomnia Severity Index), QoL (measured using the Functional Assessment of Cancer Therapy-General instrument), and cognitive complaints (measured using the Functional Assessment of Cancer Therapy-Cognitive Function instrument) were collected through validated questionnaires. RESULTS: Clinical data and questionnaires were available for 734 and 576 patients, respectively. The median patient age was 64 years, and 69% of patients were women. Twenty-one percent of patients had PTSD. Twenty-seven percent (95% CI, 23%-30%) had an adjustment in their medical oncology program, including adjournments (29%), treatment interruptions (16%), modified treatment plans (27%), or adapted monitoring (27%). Women and patients experiencing an adjustment in oncology practice had a higher odds of PTSD (odds ratio= 2.10 [95% CI, 1.07-4.14] and 1.65 [95% CI, 1.03-2.63]; P < .05). PTSD symptoms were correlated with worse scores for QoL, cognition, and insomnia. CONCLUSIONS: Twenty-one percent of patients with cancer experienced PTSD symptoms associated with poor QoL during the first COVID-19-induced lockdown. Medical oncology practice was adjusted in approximately one-quarter of patients and was associated with the occurrence of PTSD symptoms. Psychosocial support should be offered in cancer centers to promote emotional resilience and avoid PTSD symptoms in patients. Cancer 2021;0:1-10.

The Psychological Distress of Cancer Patients following the COVID-19 Pandemic First Lockdown: Results from a Large French Survey

“…In the review by Ayubi et al [ 24 ], which assessed anxiety in studies that used various validated questionnaires, prevalence in cancer patients could exceed 30% during the pandemic. In the studies by JuanJuan et al [ 25 ] and Joly et al [ 18 ], moderate to severe PTSD symptoms (IES-R score ≥ 33) was found for 52.3% and 21% of patients, respectively. JuanJuan et al’s study [ 25 ] had a particularly high prevalence of PTSD; this can be explained by the fact that it was conducted in the Hubei province of China—the epicentre of COVID-19—at the peak time point of the crisis in the country (February 2020).…”

“…These patients already experience very high levels of anxiety, depression and post-traumatic stress related to their cancer [ 14 , 15 ]. Accordingly, the current pandemic is a potential cause for increased anxiety arising from two factors: the risk of SARS-CoV-2 exposure if they come to hospital for cancer treatment, and the risk of poorer cancer outcomes—specifically the risk of cancer progression and death—due to COVID-19-related delays or changes in cancer treatment [ 16 , 17 , 18 , 19 ].…”

Post-traumatic stress symptoms in cancer patients during the COVID-19 pandemic: a one-year longitudinal study

“…The study included outpatients aged 18 and over, and receiving oncological treatment for solid or hematological malignancy during the first nationwide lockdown at the day care hospital of two French cancer centers (the François Baclesse Center and the Henri Becquerel Center). 16 Patients were enrolled between April, 16, 2020 and May, 29, 2020.…”

“…Baseline results showed that 21% of cancer patients experienced PTSD symptoms associated with poor quality of life (QoL) during the first lockdown. 16 An adjustment to medical oncology practices was implemented in approximately one-quarter of patients and was associated with the occurrence of PTSD symptoms. We present here the longitudinal follow-up of the COVIPACT cohort.…”

Letter to the Editor: The possible role of lymphadenopathy after vaccination in posttraumatic stress disorder in cancer survivors during COVID-19

“…Prior studies had shown higher risk of PTSD symptoms in cancer patients during the COVID-19 pandemic under the stress of fear of infection, whether canceling the hospital appointment or adapted monitoring [1,4]. Additionally, as the COVID-19 vaccines gradually released to the public in the first year of the pandemic, the vaccination coverage (at least one shot) had been administered to approximately 60% of the eligible population worldwide.…”