The impact of COVID-19 on cancer patients, their carers and oncology health professionals: A qualitative study

Abstract

Objective Cancer patients, carers and oncology health professionals have been impacted by the COVID-19 pandemic in many ways, but their experiences and psychosocial responses to the pandemic are still being explored. This study aimed to document the experience of Australians living with cancer, family carers, and Oncology health professionals (HPs) when COVID-19 first emerged. Methods In this qualitative study, participants (cancer patients currently receiving treatment, family carers and HPs) completed a semi-structured interview exploring their experiences of COVID-19 and the impact it had on cancer care. Participants also completed the Hospital Anxiety and Depression Scale (patients) and the Depression, Anxiety and Stress Scale (carers and HPs) to assess emotional morbidity. Thematic analysis was undertaken on qualitative data. Results 32 patients, 16 carers and 29 HPs participated. Qualitative analysis yielded three shared themes: fear and death anxiety, isolation, and uncertainty. For HPs, uncertainty incorporated the potential for moral distress and work-stress. Patients and carers scoring high on anxiety/depression measures were more likely to have advanced disease, expressed greater death anxiety, talked about taking more extreme precautionary measures, and felt more impacted by isolation. Conclusion Cancer and COVID-19 can have compounding psychological impacts on all those receiving or giving care. Practice Implications Screening for distress in patients, and burnout in HPs, is recommended. Increased compassionate access and provision of creative alternatives to face-to-face support are warrented.

Palliative care delivery changes during COVID-19 and enduring implications in oncology nursing: a rapid review

“…Patients, caregivers, and healthcare providers each experienced increased needs for psychological and spiritual supports during the pandemic, yet, reported suboptimal availability of these services, particularly in end-of-life circumstances [ 20 ▪▪ ]. Caregivers specifically desired more proactive mental health supports [ 24 ▪ ]. To address deficiencies, one specialty palliative care team leveraged the expertise of their chaplain and psychologist to offer telehealth to hospitalized patients and their caregivers with psychological and spiritual needs [ 11 ▪▪ ].…”

“…The mental health crisis stemming from providing care during COVID-19 has been dubbed a ‘second pandemic’ [ 25 ], where an estimated 31–53% of healthcare providers have reported distress, anxiety, or depression in varying degrees [ 24 ▪ , 26 ], with nurses experiencing greater risk for these outcomes [ 27 , 28 ]. These estimates constitute a significant increase in psychological morbidity among healthcare providers from prior to the pandemic [ 28 , 29 ], and may stem from the demands of providing frequent end-of-life care [ 15 , 30 ], as well as moral distress over the inability to provide optimal care amid COVID-19 mitigation [ 31 ▪ , 32 ▪ ].…”

“…Earlier discharges became more frequent during the pandemic to address hospital capacity issues. These discharges contributed to higher outpatient demands [ 19 ▪ ], impacting the social needs of patients and their caregivers [ 24 ▪ ]. Patients reported the unavailability of community-based resources, such as peer cancer support programs [ 18 ▪ ].…”

“…However, the pandemic-imposed social isolation made virtual support programs desirable over none, particularly among adolescent and young adult patients with cancer [ 34 ]. Social isolation compounded the psychological morbidity of patients/caregivers [ 24 ▪ ], most significantly for bereaved caregivers [ 35 ]. Caregivers also felt excluded from patients’ healthcare providers owing to COVID-19 mitigation.…”

Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective

“…As a consequence, the pandemic induced a need for adapted criteria for SDM processes [ 10 ], but investigations aiming at patients’ attitudes towards SDM and predictors of decisional preferences during the pandemic are very rare [ 11 , 12 ]. For example, qualitative analyses by Edge et al [ 13 ] and Butow et al [ 14 ] showed pandemic-related SDM vulnerability of specific patient groups, such as in oncology, characterized by psychological distress, fear of virus susceptibility, practical issues in daily life, disruptions to treatment and services, information needs, and caregiver issues. In addition, various aspects of uncertainty as stressors for patients were identified [ 15 ].…”