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Chen KY, Stanford O, Wenzel JA, Joyner RL, Dobs AS. Patient perspectives on cancer care during COVID-19: A qualitative study. PLoS One 2024; 19:e0306035. [PMID: 38990967 PMCID: PMC11238955 DOI: 10.1371/journal.pone.0306035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE The COVID-19 pandemic posed unique challenges to cancer-related care as health systems balanced competing risks of timely delivery of care and minimizing exposure to infection in a high-risk, immunocompromised patient population. This study aimed to better understand how pandemic-related factors affected the patient experience of cancer care during this time. METHODS We conducted fifteen semi-structured interviews with adults from rural counties in Maryland who were diagnosed with and/or actively treated for cancer at the TidalHealth healthcare network between January 2020 and October 2022. RESULTS Interviews from fifteen participants were analyzed. Two major themes emerged including COVID Impact on Care, and COVID Impact on Mental Health. Subthemes under COVID Impact on Care include Staffing Shortages, Hospital Regulations, Visitation, Importance of Advocacy, and Telehealth Utilization, and subthemes under COVID Impact on Mental Health include Loneliness, Support Networks, and Perceptions of COVID and Personal Protection. Overall, participants described positive care experiences despite notable delays, disruptions to continuity of care, difficult transitions to telemedicine, visitation policies that limited patient support, increased mental health struggles related to social distancing measures, and greater desire for patient advocacy. CONCLUSION Our findings reveal significant impacts of the COVID-19 pandemic on experiences of cancer treatment and survivorship in a more vulnerable, rural patient population with lower healthcare access and income level. Our findings suggest areas for targeted interventions to limit disruptions to quality care in future public health emergencies.
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Affiliation(s)
- Krista Y. Chen
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Olivia Stanford
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Office of Community Outreach and Engagement, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Jennifer A. Wenzel
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- School of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Robert L. Joyner
- Richard A. Henson Research Institute, TidalHealth Peninsula Regional, Salisbury, Maryland, United States of America
| | - Adrian S. Dobs
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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2
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Zhang A, Koroukian S, Owusu C, Moore SE, Momotaz H, Albert JM. Loneliness and Crowded Living Predicted Poor Health in a Sample of Cancer Patients During COVID-19 Pandemic. Clin Nurs Res 2024; 33:370-383. [PMID: 38773912 DOI: 10.1177/10547738241252889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p = .019) on the Hamilton Depression Rating Scale and improved global health (p = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p < .001) and crowded living space (p = .001, p = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p = .001) and improved global health (p = .029). Increasing access to medicine (p < .01) and satisfaction with telehealth appointments (p < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.
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Affiliation(s)
- Amy Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Siran Koroukian
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Cynthia Owusu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Scott E Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Hasina Momotaz
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffrey M Albert
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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3
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Valdelamar A, De La Hoz F, Sánchez R. Loneliness as a predictor of mortality in cancer patients, a cohort study. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:119-138. [PMID: 39079136 DOI: 10.7705/biomedica.7150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/15/2024] [Indexed: 08/04/2024]
Abstract
Introduction. Some studies have indicated that loneliness may be associated with an increased risk of mortality in cancer patients, as it can weaken treatment response and the immune system, and promote harmful behaviors, worsening the prognosis and increasing the likelihood of death. Addressing loneliness in public health is essential to provide social support and improve outcomes in cancer patients. Objective. To obtain an estimator of the unwanted loneliness-mortality association. Materials and methods. We followed a prospective cohort of 400 patients for two years (exposure=loneliness levels; outcome=mortality; sociodemographic and clinical control variables were included). A parametric survival model (log normal) was used. Results. The cohort had a median survival of 20.2 months and a mortality rate of 3.2 deaths/100 patient-months (95% CI: 2.8 to 3.7). The survival model found the following time ratios (TR): moderate level/low level: TR=0.55; 95% CI: 0.39 to 0.77; moderately high level/low level: TR=0.62; 95% CI: 0.41 to 0.93; high level/low level: TR=1.17; 95% CI: 0.31 to 4.42. Conclusion. Compared to patients with low levels of loneliness, patients with moderate or moderately high levels reach death more quickly (statistically significant TRs, adjusted for the effect of other variables in the model); this highlights the need for interventions to mitigate loneliness and promote social support in patients having cancer.
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Affiliation(s)
- Adriana Valdelamar
- Grupo del Área de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología ESE, Bogotá, D.C., Colombia; Grupo de Epidemiología y Evaluación en Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Fernando De La Hoz
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
| | - Ricardo Sánchez
- Grupo del Área de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología ESE, Bogotá, D.C., Colombia; Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
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Neville AR, Tabaczynski A, Whitehorn A, Bastas D, Trinh L. Sedentary time transitions and associations with quality of life in cancer survivors during the COVID-19 pandemic. J Psychosoc Oncol 2024:1-18. [PMID: 38693609 DOI: 10.1080/07347332.2024.2346560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Patterns in sedentary time (SED) and its impact on quality of life (QoL) in cancer survivors during the COVID-19 pandemic remains unknown. The purpose of this study was to 1) compare total and domain-specific SED before and during the pandemic; and 2) examine its association with QoL in a global sample of cancer survivors. METHODS In an online survey, cancer survivors retrospectively self-reported domain-specific SED (e.g. transportation, television) before and during the pandemic via the Domain-Specific Sitting Time Questionnaire. QoL was assessed via the Functional Assessment of Cancer Therapy (FACT)-General and FACT-Fatigue. Paired t-tests compared daily SED before and during the pandemic. Analysis of covariance compared QoL among: those who remained high (>8 h/day), remained low (<8 h/day), increased (<8 h/day to >8 h/day), or decreased (>8 h/day to <8 h/day) daily SED. RESULTS Among cancer survivors (N = 477, Mage=48.5 ± 15.4), 60.8% reported that their SED remained high, 19.7% remained low, 7.5% increased SED, and 11.9% decreased SED. Computer and television screen time significantly increased (p's<.001), while SED during transportation significantly decreased (p<.001). Sub-group analyses revealed that those who reduced SED who were normal or underweight (p=.042) or were meeting physical activity guidelines (p=.031) had significantly less fatigue than those who increased or remained high in SED, respectively. Those who remained high in SED with <3 comorbidities (p's =.005) had significantly better social well-being than those who increased SED. CONCLUSIONS As we transition to a post-pandemic era, behavioral strategies for cancer survivors should focus on reducing screen time to improve QoL and fatigue.
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Affiliation(s)
- Alyssa R Neville
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Allyson Tabaczynski
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Alexis Whitehorn
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Denise Bastas
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Linda Trinh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
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Cui C, Wang L. Role of social support in the relationship between resilience and sleep quality among cancer patients. Front Psychiatry 2024; 15:1310118. [PMID: 38690201 PMCID: PMC11058993 DOI: 10.3389/fpsyt.2024.1310118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The present study aimed to investigate the effect of resilience on sleep quality and explore the role of social support between resilience and sleep quality in cancer patients. Methods A multicenter and cross-sectional study was conducted in China from May to November 2021. A total of 202 cancer patients were recruited to complete the questionnaires composed of demographic information, Pittsburg Sleep Quality Index (PSQI), Resilience Scale-14 (RS-14), and Multidimensions Scale of Perceived Social Support (MSPSS). The associations between resilience, social support, and sleep quality were explored through hierarchical regression analysis. Results The prevalence of poor sleep quality was 50% among cancer patients. Resilience, social support, and the interaction between resilience and social support were all found to be significantly associated with sleep quality. Results of simple slope analysis indicated that the association between resilience and sleep quality were gradually decreased with the increasing social support levels (1 SD below the mean, B=-0.225, β=-0.551, P<0.001), mean social support (B=-0.147, β=-0.353, P<0.001) and high social support (1 SD above the mean, B=-0.065, β=-0.156, P<0.001). Additionally, social support mediated the effect of resilience on sleep quality among cancer patients. Discussion Poor sleep quality has been common in cancer patients. Social support could mediate and alleviate the relationship between resilience and sleep quality among cancer patients. Besides providing sufficient social support, interventions based on resilience should be applied to address sleep problems in cancer patients.
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Affiliation(s)
- ChunYing Cui
- School of Humanities and Management, Wannan Medical College, Wuhu, Anhui, China
| | - Lie Wang
- School of Public Health, China Medical University, Shenyang North New Area, Shenyang, Liaoning, China
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Smith S, Lally P, Steptoe A, Chavez-Ugalde Y, Beeken RJ, Fisher A. Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study. BMC Public Health 2024; 24:635. [PMID: 38419011 PMCID: PMC10903019 DOI: 10.1186/s12889-024-17797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND A cancer diagnosis and its treatment may be an especially isolating experience. Despite evidence that positive health behaviours can improve outcomes for people living with and beyond cancer (LWBC), no studies have examined associations between loneliness and different health behaviours in this population. This study aimed to describe the prevalence of loneliness in a large sample of UK adults LWBC and to explore whether loneliness was associated with multiple health behaviours. METHODS Participants were adults (aged ≥ 18 years) diagnosed with breast, prostate or colorectal cancer who completed the Health and Lifestyle After Cancer Survey. Loneliness was reported using the UCLA loneliness score, dichotomised into higher (≥ 6) versus lower (< 6) loneliness. Engagement in moderate-to-vigorous physical activity, dietary intake, smoking status, alcohol use, and self-reported height and weight were recorded. Behaviours were coded to reflect meeting or not meeting the World Cancer Research Fund recommendations for people LWBC. Logistic regression analyses explored associations between loneliness and health behaviours. Covariates were age, sex, ethnicity, education, marital status, living situation, cancer type, spread and treatment, time since treatment, time since diagnosis and number of comorbid conditions. Multiple imputation was used to account for missing data. RESULTS 5835 participants, mean age 67.4 (standard deviation = 11.8) years, completed the survey. 56% were female (n = 3266) and 44% (n = 2553) male, and 48% (n = 2786) were living with or beyond breast cancer, 32% (n = 1839) prostate, and 21% (n = 1210) colorectal. Of 5485 who completed the loneliness scale, 81% (n = 4423) of participants reported lower and 19% (n = 1035) higher loneliness. After adjustment for confounders, those reporting higher levels of loneliness had lower odds of meeting the WCRF recommendations for moderate-to-vigorous physical activity (Odds Ratio [OR] 0.78, 95% Confidence Internal [CI], 0.67, 0.97, p =.028), fruit and vegetable intake (OR 0.81, CI 0.67, 1.00, p =.046), and smoking (OR 0.62, 0.46, 0.84, p =.003). No association was observed between loneliness and the other dietary behaviours, alcohol, or body mass index. CONCLUSIONS Loneliness is relatively common in people LWBC and may represent an unmet need. People LWBC who experience higher levels of loneliness may need additional support to improve their health behaviours.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Phillippa Lally
- Department of Psychological Sciences, University of Surrey, GU2 7XH, Guildford, Surrey, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK
| | - Yanaina Chavez-Ugalde
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, Box 285, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, LS2 9JT, Leeds, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, Gower Street, WC1E 6BT, London, UK.
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Falade-Nwulia O, Ward K, Wagner KD, Karimi-Sari H, Hsu J, Sulkowski M, Latkin C, Nwulia E. Loneliness and fearfulness are associated with non-fatal drug overdose among people who inject drugs. PLoS One 2024; 19:e0297209. [PMID: 38381763 PMCID: PMC10880973 DOI: 10.1371/journal.pone.0297209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) experience high rates of drug overdose death with the risk of mortality increasing after each non-fatal event. Racial differences exist in drug overdose rates, with higher rates among Black people who use drugs. Psychological factors may predict drug overdose. METHODS Cross-sectional data from a survey administered to PWID in Baltimore, MD enrolled in a social network-based intervention were analyzed. Linear regression methods with generalized estimating equations were used to analyze data from indexes and network members to assess for psychological factors significantly associated with self-reported number of lifetime drug overdoses. Factors associated with number of overdoses were assessed separately by race. RESULTS Among 111 PWID enrolled between January 2018 and January 2019, 25.2% were female, 65.7% were Black, 98.2% reported use of substances in addition to opioids, and the mean age was 49.0 ± 8.3 years. Seventy-five individuals (67.6%) had a history of any overdose with a mean of 5.0 ± 9.7 lifetime overdoses reported. Reports of feeling fearful (β = 9.74, P = 0.001) or feeling lonely all of the time (β = 5.62, P = 0.033) were independently associated with number of drug overdoses. In analyses disaggregated by race, only the most severe degree of fearfulness or loneliness was associated with overdose among Black participants, whereas among White participants, any degree of fearfulness or loneliness was associated with overdose. CONCLUSIONS In this study of PWID loneliness and fearfulness were significantly related to the number of reported overdose events. These factors could be targeted in future interventions.
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Affiliation(s)
- Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Kathleen Ward
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- School of Public Health, Drexel University, Philadelphia, PA, United States of America
| | - Karla D. Wagner
- School of Public Health, University of Nevada, Reno, NV, United States of America
| | - Hamidreza Karimi-Sari
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jeffrey Hsu
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Mark Sulkowski
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Carl Latkin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Evaristus Nwulia
- Department of Psychiatry, Howard University, Washington, DC, United States of America
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Joulaei H, Parhizkar M, Fatemi M, Afrashteh S, Parhizkar P, Akrami M, Foroozanfar Z. Mental Health Care Utilization and its Barriers among Iranian Breast Cancer Survivors: A Cross-sectional Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2024; 12:44-56. [PMID: 38328011 PMCID: PMC10844875 DOI: 10.30476/ijcbnm.2023.99133.2289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024]
Abstract
Background Depression and anxiety are common comorbidities complicating the care of breast cancer patients, but many patients do not receive the needed care. We aimed to assess utilization of mental health care and its barriers in breast cancer survivors. Methods This cross-sectional study was conducted on 311 patients with breast cancer, in Iran, November 2021 to March 2022. Perceived need and utilization of mental health care and barriers to service utilization were measured based on self-report. Depression, Anxiety, and Stress Scale-21 and Multidimensional Scale of Perceived Social Support were used to assess depression, anxiety, and stress as well as social support, respectively. A linear and logistic regression model was used to analyze the data using SPSS version 22. A P-value less than 0.05 was considered statistically significant. Results 70.1% of the participants perceived need for mental health care, 28.0% of them had used mental health services, and 72% were classified as having unmet needs. The most common perceived barrier to service use was patients' self-adequacy. The prevalence of extremely severe levels of depression, anxiety, and stress was 14.8%, 23.5%, and 10.6%. Also, 48.6%, 78.5%, and 75.6% of patients received a high level of social support from friends, family, and significant others. Conclusion Findings highlight a substantial unmet need for mental health care and low utilization of mental health services among breast cancer survivors. Given the significant prevalence of depression, anxiety, and stress in this population, it is imperative to address the underutilization of mental health services and to further examine the barriers preventing patients from seeking the care they require.
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Affiliation(s)
- Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Parhizkar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Fatemi
- Department of Psychology, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Pardis Parhizkar
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Majid Akrami
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Kaur H, Pavela G, Pekmezi DW, Rogers LQ, Cole WW, Parrish KB, Sayer RD, Wyatt HR, Demark-Wahnefried W. Dietary Barriers Appear to Influence the Effects of a Dyadic Web-Based Lifestyle Intervention on Caloric Intake and Adiposity: A Mediation Analysis of the DUET Trial. Nutrients 2023; 15:4918. [PMID: 38068776 PMCID: PMC10708365 DOI: 10.3390/nu15234918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Mechanisms that explain behavior change within web-based lifestyle interventions are not well-studied. This secondary analysis explores whether the effects of the DUET web-based lifestyle intervention on diet, physical activity, and/or adiposity are mediated through changes in self-efficacy, social support, and perceived barriers (key constructs of social cognitive theory). Data on mediators, diet quality, caloric intake, moderate-to-vigorous physical activity (MVPA), weight, and waist circumference (WC) were analyzed from 112 cancer survivors and their partners enrolled in the DUET intervention. Mediation analyses were performed using Mplus to execute regression analyses and determine associations. Mediation analyses supported an effect of the intervention on caloric intake (-3.52, 95% CI [-8.08 to -0.84]), weight (-1.60, CI [-3.84 to -0.47]), and WC (-0.83, CI [-1.77 to -0.18]), interpreting these negative associations as intervention induced reductions in dietary barriers. Higher social support was significantly and positively associated with, but not a mediator for, improvements in self-reported and accelerometry-measured MVPA (b = 0.69, CI [0.19, 1.24]) and (b = 0.55, CI [0.15, 1.00]), respectively. Self-efficacy did not appear to mediate the intervention's effects. Findings suggest that the effects of the DUET intervention on diet and adiposity stem from reducing perceived barriers to a healthful, low-calorie diet.
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Affiliation(s)
- Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.D.S.); (H.R.W.); (W.D.-W.)
| | - Gregory Pavela
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (G.P.); (D.W.P.); (W.W.C.); (K.B.P.)
| | - Dori W. Pekmezi
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (G.P.); (D.W.P.); (W.W.C.); (K.B.P.)
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA;
| | - Laura Q. Rogers
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA;
- Department of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA
| | - William W. Cole
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (G.P.); (D.W.P.); (W.W.C.); (K.B.P.)
| | - Kelsey B. Parrish
- Department of Health Behavior, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (G.P.); (D.W.P.); (W.W.C.); (K.B.P.)
| | - R. Drew Sayer
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.D.S.); (H.R.W.); (W.D.-W.)
- Department of Family and Community Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL 35205, USA
| | - Holly R. Wyatt
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.D.S.); (H.R.W.); (W.D.-W.)
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA; (R.D.S.); (H.R.W.); (W.D.-W.)
- O’Neal Comprehensive Cancer Center at UAB, Birmingham, AL 35233, USA;
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Lau J, Koh WL, Ng JS, Khoo AMG, Tan KK. Understanding the mental health impact of COVID-19 in the elderly general population: A scoping review of global literature from the first year of the pandemic. Psychiatry Res 2023; 329:115516. [PMID: 37797442 DOI: 10.1016/j.psychres.2023.115516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023]
Abstract
Self-isolation was common in the first year of COVID-19. While necessary, it also increased vulnerability to adverse mental health among elderly (i.e. aged 60 and above). This review seeks to summarise the outcomes, measures, and protective and risk factors of elderly mental health in the first year of COVID-19. Four international databases were systematically searched from inception to August 2021. Forty-five studies examining elderly mental health outcomes specific to COVID-19 were included - one was qualitative, 29 used cross-sectional quantitative methods, and 15 were longitudinal. Anxiety and depression were examined most commonly and consistently, largely with well-validated scales. Older age, female sex, poor financial status, being unmarried, high loneliness, low social engagement, low resilience and more severe pandemic measures were associated with poor elderly mental health outcomes. Ten of 13 longitudinal studies found deteriorations in elderly mental health outcomes over time. More consistent measures are needed to understand the pandemic's impact on elderly mental health. Our findings also suggest that socialising through digital mediums may not be helpful, and might even exacerbate loneliness. While the elderly are generally considered a high-risk population, higher-risk subpopulations were identified. We conclude by suggesting a multilevel approach to safeguard elderly mental health for future crises.
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Affiliation(s)
- Jerrald Lau
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Level 8. 1E Kent Ridge Road, 119228, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wei-Ling Koh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Level 8. 1E Kent Ridge Road, 119228, Singapore
| | - Janelle Shaina Ng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Level 8. 1E Kent Ridge Road, 119228, Singapore
| | - Athena Ming-Gui Khoo
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Level 8. 1E Kent Ridge Road, 119228, Singapore
| | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Level 8. 1E Kent Ridge Road, 119228, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Stevens CJ, Wechsler S, Ejem DB, Khalidi S, Coffee-Dunning J, Morency JL, Thorp KE, Codini ME, Newman RM, Echols J, Cloyd DZ, dos Anjos S, Muse C, Gallups S, Goedeken SC, Flannery K, Bakitas MA, Hegel MT, Lyons KD. A Process Evaluation of Intervention Delivery for a Cancer Survivorship Rehabilitation Clinical Trial Conducted during the COVID-19 Pandemic. Curr Oncol 2023; 30:9141-9155. [PMID: 37887560 PMCID: PMC10605104 DOI: 10.3390/curroncol30100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
The purpose of the present study was to conduct a process evaluation of intervention delivery for a randomized controlled trial (RCT) conducted during the COVID-19 pandemic (NCT03915548). The RCT tested the effects of a telephone-delivered behavioral intervention on changes in breast cancer survivors' satisfaction with social roles and activities, as compared to an attention control condition. This process evaluation examined (a) fidelity monitoring scores; (b) participants' perceived benefit ratings for gaining confidence, reducing distress, adjusting habits and routines, setting goals, and increasing exercise; and (c) field notes, email communications, and transcripts of coach supervision and debriefing sessions. The behavioral and attention control conditions were delivered with a high degree of fidelity (global quality rating score for the BA/PS condition was M = 4.6 (SD = 0.6) and M = 4.9 (SD = 0.3) for the attention control condition, where "5" is the highest rating). The behavioral intervention participants perceived greater benefits than the control participants pertaining to goal setting, t(248) = 5.73, p = <0.0001, adjusting habits and routines, t(248) = 2.94, p = 0.0036, and increasing exercise, t(248) = 4.66, p = <0.0001. Moreover, coaches' perceptions regarding the behavioral intervention's therapeutic aspects aligned with the study's a priori conceptual model including the use of a structured process to set small, observable goals and facilitate the independent use of problem-solving skills. However, coaches also noted that aspects of the attention control condition, including the perceived relevance of the educational content and opportunities for social support, may have made it more therapeutically potent than intended. The pandemic may have affected the activity goals behavioral intervention participants could set as well as augmented the relevancy of social support provided in both conditions.
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Affiliation(s)
- Courtney J. Stevens
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Stephen Wechsler
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Deborah B. Ejem
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Khalidi
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Jamme L. Morency
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Karen E. Thorp
- Department of Rehabilitation Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Megan E. Codini
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Robin M. Newman
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA 02215, USA
| | - Jennifer Echols
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Danielle Z. Cloyd
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah dos Anjos
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Colleen Muse
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Sarah Gallups
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Susan C. Goedeken
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kaitlin Flannery
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
| | - Marie A. Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Mark T. Hegel
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, School of Rehabilitation Sciences, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02129, USA (K.D.L.)
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12
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Jiang Y, Li SM, Yang QP, Ji YY, Zhu HH. Socio-demographic factors associated with depression maybe more important in the post-epidemic era. QJM 2023; 116:818. [PMID: 37279736 DOI: 10.1093/qjmed/hcad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Y Jiang
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - S M Li
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Q P Yang
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - Y Y Ji
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
| | - H H Zhu
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu 214151, China
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13
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Gaughan AA, MacEwan SR, Rush LJ, Gatti‐Mays ME, Pariser AC, McAlearney AS. Perspectives of patients undergoing neoadjuvant chemotherapy for breast cancer during the COVID-19 pandemic. Cancer Rep (Hoboken) 2023; 6:e1882. [PMID: 37584345 PMCID: PMC10598258 DOI: 10.1002/cnr2.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a lapse in routine health care and cancer screenings for many individuals. This study sought to improve our understanding of the impact of the COVID-19 pandemic on women being treated for breast cancer, both in general, and specifically related to their diagnosis. METHODS Semi-structured interviews were conducted between August 2021 and February 2022 with women who were receiving neoadjuvant chemotherapy for early-stage breast cancer at the Stefanie Spielman Comprehensive Breast Center in Columbus, Ohio. Interviews were recorded and transcribed verbatim. Transcripts were coded using deductive dominant thematic analysis and inductive coding that allowed for categorization of data as well as identification of emergent themes. RESULTS Data collected from our 19 interviews revealed that the COVID-19 pandemic posed important challenges for breast cancer patients including fear of COVID-19 infection and feelings of isolation. Most interviewees noted they had been vaccinated against COVID-19 because of a desire to protect themselves and others from getting sick. Some women also expressed concerns about having delayed their screening mammograms due to the pandemic. Several patients described unexpected positive aspects of the pandemic such as being able to spend more time with family and having the ability to continue working because of the option to work from home during their cancer treatment. CONCLUSIONS Our findings provide important insight about the impact of COVID-19 on breast cancer patients. We highlight the positives that have been reported because of the pandemic, as well as the need to address delayed breast cancer screening.
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Affiliation(s)
- Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Sarah R. MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
- Division of General Internal MedicineCollege of Medicine, The Ohio State UniversityColumbusOHUSA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Margaret E. Gatti‐Mays
- Pelotonia Institute for Immuno‐Oncology, Division of Medical OncologyThe Ohio State University Comprehensive Cancer Center – The JamesColumbusOhioUSA
| | - Ashley C. Pariser
- Pelotonia Institute for Immuno‐Oncology, Division of Medical OncologyThe Ohio State University Comprehensive Cancer Center – The JamesColumbusOhioUSA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
- Department of Family and Community MedicineCollege of Medicine, The Ohio State UniversityColumbusOHUSA
- Department of Biomedical InformaticsCollege of Medicine, The Ohio State UniversityColumbusOHUSA
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14
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Zeilinger EL, Knefel M, Schneckenreiter C, Pietschnig J, Lubowitzki S, Unseld M, Füreder T, Bartsch R, Masel EK, Adamidis F, Kum L, Kiesewetter B, Zöchbauer-Müller S, Raderer M, Krauth MT, Staber PB, Valent P, Gaiger A. The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients. Int J Clin Health Psychol 2023; 23:100404. [PMID: 37663044 PMCID: PMC10469068 DOI: 10.1016/j.ijchp.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Objective We aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemic. Method In this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factors. Results In the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distress. Conclusions Although the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.
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Affiliation(s)
- Elisabeth Lucia Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
| | - Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine, Landesklinikum Baden-Mödling, Baden, Austria
| | - Carmen Schneckenreiter
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Pietschnig
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Matthias Unseld
- Academy for Ageing Research, Haus der Barmherzigkeit, Vienna, Austria
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thorsten Füreder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Rupert Bartsch
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eva Katharina Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Feroniki Adamidis
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lea Kum
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesewetter
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Markus Raderer
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maria Theresa Krauth
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Philipp B Staber
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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15
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Myers C, Waldron C, Bennett K, Cahir C. Impact of the COVID-19 pandemic on women living with and beyond breast cancer: a qualitative study of women's experiences and how they varied by social determinants of health. BMC Cancer 2023; 23:867. [PMID: 37715181 PMCID: PMC10503161 DOI: 10.1186/s12885-023-11351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The aim of this study is to explore the general impact of COVID-19 on the access and use of BC services and support and overall well-being in women living with a diagnosis of breast cancer (BC) and to investigate how these experiences varied by the social determinants of health (SDH). METHODS Semi-structured qualitative interviews were conducted with women selected through stratified purposive sampling to ensure data were available on information-rich cases. Interviews were conducted in early 2021 during government restrictions due to COVID-19. Thematic analysis was conducted to obtain overall experience and variation of experience based on SDH. RESULTS Thirty seven women participated in interviews. Three major themes, with additional subthemes, emerged from analysis: 1. breast cancer services (screening, active treatment, and routine care); 2. breast cancer support and communication (continuity of care, role of liaison, and support services); and 3. quality of life (QoL) and well-being (emotional well-being; social well-being; and functional well-being). Women's experiences within the themes varied by socio-economic status (SES) and region of residence (urban/rural) specifically for BC services and support. CONCLUSION The pandemic impacted women living with and beyond BC, but the impact has not been the same for all women. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice, including standardized BC services, improved communication, and enhancement of cancer support services.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Catherine Waldron
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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16
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Kim J, Linos E, Dove MS, Hoch JS, Keegan TH. Impact of COVID-19, cancer survivorship and patient-provider communication on mental health in the US Difference-In-Difference. NPJ MENTAL HEALTH RESEARCH 2023; 2:14. [PMID: 38609572 PMCID: PMC10955924 DOI: 10.1038/s44184-023-00034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/15/2023] [Indexed: 04/14/2024]
Abstract
Poor mental health has been found to be more prevalent among those with cancer and is considered a public health crisis since COVID-19. This study assessed the impact of COVID-19 and cancer survivorship on mental health and investigated factors, including online patient-provider communications (OPPC; email/internet/tablet/smartphone), associated with poor mental health prior to and during the early COVID-19. Nationally representative Health Information National Trends Survey data during 2017-2020 (n = 15,871) was used. While the prevalence of poor mental health was high (40-42%), Difference-In-Difference analyses revealed that cancer survivorship and COVID-19 were not associated with poor mental health. However, individuals that used OPPC had 40% higher odds of poor mental health. Low socioeconomic status (low education/income), younger age (18-64 years), and female birth gender were also associated with poor mental health. Findings highlight the persistence of long-standing mental health inequities and identify that OPPC users might be those who need mental health support.
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Affiliation(s)
- Jiyeong Kim
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
- Stanford Center for Digital Health, School of Medicine, Stanford, CA, USA.
| | - Eleni Linos
- Stanford Center for Digital Health, School of Medicine, Stanford, CA, USA
- Program for Clinical Research & Technology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Melanie S Dove
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Jeffrey S Hoch
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Theresa H Keegan
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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17
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Zhao F, Freeman JQ, Jaskowiak N, Fleming GF, Nanda R, Lauderdale DS, Olopade OI, Huo D. Stress, Isolation, and Sleep Quality among Breast Cancer Survivors throughout the COVID-19 Pandemic: A Longitudinal Study in a Multi-Ethnic Cohort. RESEARCH SQUARE 2023:rs.3.rs-3231825. [PMID: 37609132 PMCID: PMC10441518 DOI: 10.21203/rs.3.rs-3231825/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose This study examined how stress, isolation, and sleep quality were impacted throughout the COVID-19 pandemic among breast cancer survivors (BCS). Methods BCS enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed in 2020, 2021, and 2022. An 11-item isolation/stress score was repeatedly measured in each survey and its changes were examined through mixed-effects models. Sleep quality was assessed in 2022 by the Insomnia Severity Index (ISI). Results In total, 1899 BCS responded (response rate: 62.8%), of whom 69% were White and 24% Black (median time since diagnosis: 5.1 years, IQR: 2.3-9.2). The isolation/stress score decreased significantly from 2020 to 2022 for White BCS, but only started declining for Black BCS in 2022. Consequently, although there were no significant racial difference in 2020, Black BCS had significantly higher isolation/stress scores in 2021 and 2022 (P < .01), while it became nonsignificant after adjusting for socioeconomic factors. BCS who were single, on Medicaid, without a high school degree, or with annual household income <$35,000 had significantly higher isolation/stress scores. Regarding sleep quality, 48% of BCS reported clinically-significant insomnia (ISI ≥ 8), and insomnia was strongly associated with higher isolation/stress scores (P-trend < .001). Conclusions Our findings suggested that the isolation/stress level improved among BCS as the pandemic subsided, but this positive trend was not observed equally across racial/ethnic groups potentially due to lack of resources. Implications for Cancer Survivors Additional resources, such as access to counseling services and sleep assistance programs, might support the post-pandemic recovery of undersevered BCS.
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18
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Myers C, Bennett K, Cahir C. Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes. Int J Qual Health Care 2023; 35:mzad048. [PMID: 37497806 PMCID: PMC10373113 DOI: 10.1093/intqhc/mzad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
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19
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Elayoubi J, Haley WE, Nelson ME, Hueluer G. How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke. Stroke 2023; 54:1830-1838. [PMID: 37363947 PMCID: PMC10313154 DOI: 10.1161/strokeaha.122.042386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke. METHODS This is a longitudinal study, which included 898 participants with incident stroke from the HRS study (Health and Retirement Study) between 1998 and 2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment. RESULTS Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Prestroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared with one's prestroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms. CONCLUSIONS Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.
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Affiliation(s)
- Joanne Elayoubi
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - William E. Haley
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Monica E. Nelson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Gizem Hueluer
- Department of Psychology, University of Bonn, Bonn, Germany
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20
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Onesti CE, Vari S, Minghelli D, Nardozza F, Rossi B, Sperati F, Checcucci E, Faltyn W, Cercato MC, Cosimati A, Salvatori F, Biagini R, Ciliberto G, Ferraresi V, Maggi G. Quality of life and emotional distress in sarcoma patients diagnosed during COVID-19 pandemic: a supplementary analysis from the SarCorD study. Front Psychol 2023; 14:1078992. [PMID: 37333608 PMCID: PMC10273400 DOI: 10.3389/fpsyg.2023.1078992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Background The COVID-19 outbreak had a negative psychological impact on cancer patients. In this study, we analyzed emotional distress and quality of life in patients diagnosed with sarcoma during the first year of the pandemic compared to the previous year. Methods We retrospectively enrolled patients with soft tissue, bone sarcoma, and aggressive benign musculoskeletal diseases diagnosed during the pandemic (COVID group) or the year before (control group) at the IRCCS Regina Elena National Cancer Institute in Rome. Patients who had undergone a psychological assessment with the EORTC QLQ-C30 and the Distress Thermometer at diagnosis were included in the final analysis. We analyzed whether there is a difference in the various domains of quality of life between the two groups and whether there are changes over time in each group. Results We enrolled 114 patients (72 control group; 42 COVID group), affected by soft tissue (64%), bone sarcoma (29%), and aggressive benign musculoskeletal diseases (7%). We did not observe significant differences in the health-related quality of life domains in the control and COVID groups, except for the financial domain (p = 0.039), with 9.7% vs. 23.8% of patients with a score > 0 in the control and COVID groups, respectively. We observed emotional distress at diagnosis in 48.6% of patients in the control group vs. 69.0% in the COVID group (p = 0.034). In the control group, we observed an improvement in physical function (p = 0.043) and in QoL (p = 0.022), while in the COVID group, we observed a deterioration in role function (p = 0.044) during follow-up. In the COVID group, 22.2% of patients were concerned about COVID-19, 61.1% by tumor, 91.1% stated that the pandemic worsened their subjective perception of cancer, and 19.4% perceived that their quality of care had worsened. Conclusion We observed a higher level of distress among patients diagnosed during the pandemic compared to the year before, probably due to the increased concern for both infection and cancer, the worsened perception of health status, and the perception of a poorer quality of health care.
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Affiliation(s)
- Concetta Elisa Onesti
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sabrina Vari
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Denise Minghelli
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Nardozza
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Rossi
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Elisa Checcucci
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Wioletta Faltyn
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Cecilia Cercato
- Digital Library “R. Maceratini”, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Cosimati
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- University of Rome “Sapienza”, Rome, Italy
| | - Francesca Salvatori
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- University of Rome “Sapienza”, Rome, Italy
| | - Roberto Biagini
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Virginia Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gabriella Maggi
- Psychology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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21
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Pilleron S, Sun V, Ayala AP, Haase KR, Arthur EK, Kenis C, Roggendorf S, Krok-Schoen JL, Trevino K, Schmidt H, Hannan M, Nikita N, Monginot S, Navarrete E, Puts M. Loneliness in older adults living with cancer: A scoping review of the quantitative and qualitative evidence on behalf of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. J Geriatr Oncol 2023; 14:101519. [PMID: 37179207 PMCID: PMC10641442 DOI: 10.1016/j.jgo.2023.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Loneliness is common in older adults. Cancer and its treatments can heighten loneliness and result in poor outcomes. However, little is known about loneliness in older adults with cancer. Our objective was to provide an overview of the prevalence of loneliness, contributing factors, evolution during the cancer trajectory, impact on treatment, and interventions to reduce loneliness. MATERIALS AND METHODS We conducted a scoping review including studies on loneliness in adults with cancer aged ≥65. Original, published studies of any designs (excluding case reports) were included. A two-step screening process was performed. RESULTS Out of 8,720 references, 19 studies (11 quantitative, 6 qualitative, 2 mixed-methods), mostly from the United States, Netherlands, and/or Belgium, and most published from 2010, were included. Loneliness was assessed by the De Jong Gierveld Loneliness Scale, and the UCLA loneliness scale. Up to 50% of older adults felt lonely. Depression and anxiety were often correlated with loneliness. Loneliness may increase over the first 6-12 months during treatment. One study assessed the feasibility of an intervention aiming at reducing primarily depression and anxiety and secondarily, loneliness in patients with cancer aged ≥70 after five 45-min sessions with a mental health professional. No studies investigated the impact of loneliness on cancer care and health outcomes. DISCUSSION This review documents the scarcity of literature on loneliness in older adults with cancer. The negative impacts of loneliness on health in the general population are well known; a better understanding of the magnitude and impact of loneliness in older adults with cancer is urgently warranted.
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Affiliation(s)
- Sophie Pilleron
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK; Ageing, Cancer, and Disparities Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445 Strassen, Luxembourg.
| | - Virginia Sun
- Department of Population Sciences and Department of Surgery, City of Hope, Duarte, California, USA
| | - Ana Patricia Ayala
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Kristen R Haase
- School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, Canada
| | | | - Cindy Kenis
- Department of General Medical Oncology and Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sigrid Roggendorf
- Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-, Wittenberg, Germany
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kelly Trevino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Schmidt
- Department for Radiation Medicine and Institute of Health and Nursing Science, Medical Faculty of Martin Luther University Halle-Wittenberg, Wittenberg, Germany
| | - Michelle Hannan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Nikita Nikita
- Division of Population Science, Department of Medical Oncology, Philadelphia, PA, USA
| | - Susie Monginot
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Erna Navarrete
- Department of Occupational Therapy and Occupational Science, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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22
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Sarkar S, Arakelyan S, Choa E, Poghosyan H. The role of financial security in loneliness or sadness among Medicare-enrolled cancer survivors during the COVID-19 pandemic. J Geriatr Oncol 2023; 14:101507. [PMID: 37216846 PMCID: PMC10123351 DOI: 10.1016/j.jgo.2023.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION This study aims to estimate the relative decreased rate of financial security and increased rate of loneliness or sadness during the COVID-19 pandemic and investigate the association between financial security and loneliness or sadness among Medicare beneficiaries with a cancer history. MATERIAL AND METHODS We examined population-based, cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 survey. The study cohort included 1,632 Medicare beneficiaries (aged ≥65 years) with self-reported cancer history. The outcome was feelings of loneliness or sadness, and the independent variable was financial security during the 2020-2021 winter surge of COVID-19. We conducted weighted descriptive statistics, a cross-tabulation analysis, and multivariable logistic regression analyses. RESULTS Overall, 18.8% of cancer survivors reported increased feelings of loneliness or sadness and 11.2% reported decreased financial security during the 2020-2021 winter surge of COVID-19. Cancer survivors who reported decreased financial security had 93% higher odds of increased feelings of loneliness or sadness compared to those who reported feeling more or about the same financial security (Adjusted odds ratio [AOR] = 1.93; 95% Confidence Interval [CI] 1.25-3.01; p <0.004). DISCUSSION Decreased financial security and increased feelings of loneliness or sadness were prevalent among cancer survivors. Additional screenings and interventions beyond what are currently available are needed to ease the socioeconomic vulnerabilities experienced by cancer survivors.
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Affiliation(s)
| | - Stella Arakelyan
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, Edinburgh University, Edinburgh, UK.
| | | | - Hermine Poghosyan
- Yale University School of Nursing, Orange, CT, USA; COPPER Center, Yale School of Medicine, New Haven, CT, USA.
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23
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He C, Wu C, He Y, Yan J, Lin Y, Wan Y, Xue S, Gao F, Chang W, Liu R, Yang T, Lang H, Cao B. Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis. Support Care Cancer 2023; 31:363. [PMID: 37249713 DOI: 10.1007/s00520-023-07798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The goal of this study is to investigate the social isolation (SI) subtypes of patients with breast cancer (BC) and to explore its influencing factors. METHODS A sample of 303 BC patients participated in the study from September to December, 2021. Latent profile analysis (LPA) was performed to identify SI clusters based on the three sub-scales of the Chinese version of the Social Anxiety Scale, the Chinese version of the Social Avoidance and Distress Scale, and the Chinese version of the Loneliness Scale. RESULTS We found that SI can be divided into three categories: high-level (Class 1), middle-level (Class 2), and low-level (Class 3), accounting for 20.46%, 33.00%, and 46.54%, respectively. Compared to Class 3, Class 1, which had the lower average monthly income per family member (RMB) (< 3000: OR = 5.298, P = .021; 3000 ~ 5000: OR = 5.320, P = .018), was more likely to suffer from SI due to occupation (Laborer: OR = 12.023, P = .009). Surgery (OR = 14.138, P < .001; OR = 2.777, P = .020), chemotherapy (OR = 10.224, P = .001; OR = 3.545, P = .001); poorer family functioning (OR = .671, P < .001; OR = .801, P = .002), and lower levels of self-transcendence (OR = .806, P < .001; OR = .911, P < .001) were important influencing factors for SI in Class 1 and Class 2 compared to Class 3. CONCLUSION SI is classifiably heterogeneous among patients with BC. Strategies that identify characteristics of SI and give targeted intervention focusing on family functioning and improving self-transcendence levels contribute to the prevention of SI among patients with BC.
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Affiliation(s)
- Chunyan He
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Chao Wu
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yang He
- Department of Psychology, Fourth Military Medical University, Shaanxi, China
| | - Jiaran Yan
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yawei Lin
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yi Wan
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shuzhi Xue
- Shaanxi Province People's Hospital, Shaanxi, China
| | - Fangning Gao
- Tangdu Hospital Affiliated to Air Force Military Medical University, Shaanxi, China
| | - Wei Chang
- Department of Aerospace Medicine, Fourth Military Medical University, Center for Aerospace Clinical Medicine, Shaanxi, China
| | - Rongrong Liu
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Tianqi Yang
- Department of Psychology, Fourth Military Medical University, Shaanxi, China
| | - Hongjuan Lang
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Baohua Cao
- Department of Nursing, Fourth Military Medical University, No.169 Changle West Road, Xi'an, 710032, Shaanxi, China.
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24
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Durak M, Karakose S, Yow WQ. Editorial: Late-life psychopathology. Front Psychol 2023; 14:1204202. [PMID: 37303896 PMCID: PMC10249054 DOI: 10.3389/fpsyg.2023.1204202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Affiliation(s)
- Mithat Durak
- Department of Psychology, Bolu Abant Izzet Baysal University, Bolu, Türkiye
| | - Selin Karakose
- College of Medicine, Florida State University, Tallahassee, FL, United States
| | - W. Quin Yow
- Humanities, Arts and Social Sciences, Singapore University of Technology and Design, Singapore, Singapore
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25
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Bargon CA, Mink van der Molen DR, Batenburg MCT, van Stam LE, van Dam IE, Baas IO, Veenendaal LM, Maarse W, Sier M, Schoenmaeckers EJP, Burgmans JPJ, Bijlsma RM, van der Leij F, Doeksen A, Young-Afat DA, Verkooijen HM. Physical and mental health of breast cancer patients and survivors before and during successive SARS-CoV-2-infection waves. Qual Life Res 2023:10.1007/s11136-023-03400-6. [PMID: 37016089 PMCID: PMC10072805 DOI: 10.1007/s11136-023-03400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE During the first SARS-CoV-2-infection wave, a deterioration in emotional well-being and increased need for mental health care were observed among patients treated or being treated for breast cancer. In this follow-up study, we assessed patient-reported quality of life (QoL), physical functioning, and psychosocial well-being during the second SARS-CoV-2-infection wave in a large, representative cohort. METHODS This longitudinal cohort study was conducted within the prospective, multicenter UMBRELLA breast cancer cohort. To assess patient-reported QoL, physical functioning and psychosocial well-being, COVID-19-specific surveys were completed by patients during the first and second SARS-CoV-2-infection waves (April and November 2020, respectively). An identical survey was completed by a comparable reference population during the second SARS-CoV-2-infection waves. All surveys included the validated EORTC-QLQ-C30/BR23, HADS and "De Jong-Gierveld Loneliness" questionnaires. Pre-COVID-19 EORTC-QLQ-C30/BR23 and HADS outcomes were available from UMBRELLA. Response rates were 69.3% (n = 1106/1595) during the first SARS-CoV-2-infection wave and 50.9% (n = 822/1614) during the second wave. A total of 696 patients responded during both SARS-CoV-2-infection waves and were included in the analysis comparing patient-reported outcomes (PROs) during the second SARS-CoV-2-infection wave to PROs during the first wave. Moreover, PROs reported by all patients during the second SARS-CoV-2-infection wave (n = 822) were compared to PROs of a similar non-cancer reference population (n = 241) and to their pre-COVID-19 PROs. RESULTS Patient-reported QoL, physical functioning, and psychosocial well-being of patients treated or being treated for breast cancer remained stable or improved from the first to the second SARS-CoV-2-infection wave. The proportion of emotional loneliness reduced from 37.6 to 29.9% of patients. Compared to a similar non-cancer reference population, physical, emotional, and cognitive functioning, future perspectives and symptoms of dyspnea and insomnia were worse in patients treated or being treated for breast cancer during the second SARS-CoV-2-infection wave. PROs in the second wave were similar to pre-COVID-19 PROs. CONCLUSION Although patients scored overall worse than individuals without breast cancer, QoL, physical functioning, and psychosocial well-being did not deteriorate between the first and second wave. During the second wave, PROs were similar to pre-COVID-19 values. Overall, current findings are cautiously reassuring for future mental health of patients treated or being treated for breast cancer.
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Affiliation(s)
- Claudia A Bargon
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
| | - Dieuwke R Mink van der Molen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marilot C T Batenburg
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lilianne E van Stam
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Iris E van Dam
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Inge O Baas
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | | | - Wiesje Maarse
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maartje Sier
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
- Department of Surgery, Rivierenland Hospital, Tiel, The Netherlands
| | | | | | - Rhodé M Bijlsma
- Department of Medical Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Femke van der Leij
- Department of Radiation Oncology, University Medical Centre Utrecht, Cancer Centre, Utrecht, The Netherlands
| | - Annemiek Doeksen
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Centre Utrecht, Cancer Centre, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Utrecht University, Utrecht, The Netherlands.
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26
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Elayoubi J, Haley WE, Nelson ME, Hueluer G. "How Social Connection and Engagement Relate to Functional Limitations and Depressive Symptoms Outcomes After Stroke". MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.07.23286965. [PMID: 36945464 PMCID: PMC10029024 DOI: 10.1101/2023.03.07.23286965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Background Stroke commonly leads to disability and depression. Social connection and engagement can be protective against functional decline and depression in the general population. We investigated the effects of social connection and engagement on trajectories of function and depressive symptoms in stroke. Methods Participants were 898 individuals with incident stroke from the Health and Retirement Study between 1998-2012. Multilevel modeling was used to examine associations of social connection and engagement with changes in functional limitations in instrumental activities of daily living (IADLs) and depressive symptoms over time. Models controlled for age, gender, education, and race/ethnicity. Moderation analyses examined whether high social connection and engagement reduced depressive symptoms for survivors with high IADL impairment. Results Social connection and engagement were generally associated with fewer IADL limitations and depressive symptoms at the time of stroke and after stroke. For example, participants who felt lonely and did not provide help to others before stroke had more IADL limitations. Pre-stroke volunteering was associated with less increase in IADL limitations with stroke and increase in having friends and providing help to others compared to one's pre-stroke status were associated with fewer IADL limitations after stroke. For depressive symptoms, participants who felt lonely and did not have a friend or partner before stroke had more depressive symptoms, and participants who had children residing nearby before stroke showed less increase in depressive symptoms. Moderation effects were not found for social connection and engagement on high IADL impairment and depressive symptoms. Conclusions Findings suggest that social connection and engagement may reduce the negative physical and psychological outcomes of stroke, both at baseline and after stroke. Efforts to enhance social engagement and diminish loneliness may both enhance population well-being and enhance resilience and recovery from stroke and other illnesses.
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Sex-specific impacts of social isolation on loneliness, depressive symptoms, cognitive impairment, and biomarkers: Results from the social environment and biomarker of aging study. Arch Gerontol Geriatr 2023; 106:104872. [PMID: 36493576 DOI: 10.1016/j.archger.2022.104872] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/03/2022] [Accepted: 11/19/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate sex-specific associations between social isolation and psychological outcomes and biomarkers among community-dwelling middle-aged and older adults using a nationally representative population-based cohort study. METHODS Data from 757 participants from the Social Environment and Biomarkers of Aging Study (SEBAS) were retrieved for analysis, and all participants were stratified by sex. The associations between social isolation and psychological outcomes (loneliness, depressive symptoms, and cognitive impairment) at the 4-year follow-up were examined by multivariate logistic regression models, and associations between social isolation and biomarkers at the 4-year follow-up were examined by multivariate generalized linear models (GLMs). RESULTS For men, social isolation was not associated with the development of loneliness. However, being married (adjusted odds ratio (aOR) 0.32 [95% confidence interval (CI) 0.13-0.74], p<0.001) was associated with a lower risk of loneliness, indicating potential protective effects of marriage for men. On the other hand, social isolation was associated with a 2-fold higher risk of loneliness in women (aOR 2.26 [1.01-5.09], p<0.001). Social isolation was not associated with depressive symptoms after adjusting for other demographics. For men, being married (aOR 0.51 [0.26-0.99], p<0.05) or having good self-reported health (aOR 0.44 [0.21-0.92], p<0.05) was protective against depressive symptoms. For women, only good self-reported health (aOR 0.30 [0.13-0.70], p<0.01) provided protective effects against depressive symptoms. Similarly, other demographic factors (being married and having a higher educational level) but not social isolation were associated with lower risks of cognitive impairment. No significant associations were noted between social isolation and selected biomarkers. CONCLUSIONS Sex-different associations between social isolation and loneliness were noted; the effects of demographic factors, such as being married, self-reported health status, and high education levels, on subsequent loneliness, depression, and cognitive function were also sex-different. Further intervention studies are needed to explore sex-specific approaches to deal with the interplay of social isolation, loneliness, psychological outcomes and other demographic factors.
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Ko E, Nguyen-Grozavu F, Valadez Galindo A. "I Had to Do It All Alone": Hispanic Perspectives on Navigating Breast Cancer Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4163. [PMID: 36901173 PMCID: PMC10002428 DOI: 10.3390/ijerph20054163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Cancer patients are at a high risk for COVID infection and its corresponding impacts on treatment delay, social isolation, and psychological distress. Hispanic breast cancer patients may be more vulnerable due to a lack of resources and language barriers, widening disparities in cancer care. This qualitative study explored the challenges and obstacles to cancer care during the COVID pandemic among 27 Hispanic females from a United States-Mexico border region. Data were collected via individual in-depth interviews and analyzed using thematic analysis. The majority of the participants were interviewed in Spanish. More than half (55.6%, n = 15) were diagnosed with breast cancer within the prior year to the interview. One-third of the participants (33.3%, n = 9) reported that COVID somewhat to greatly impacted their cancer care. Study findings revealed potential barriers and challenges for cancer care at multiple levels (e.g., medical, psychosocial, financial level) during the COVID pandemic. Five major themes reported include: (1) delays in testing and access to care; (2) fear of COVID infection; (3) social isolation and reduced social support; (4) challenges in navigating treatments alone; and (5) financial hardships. Our findings highlight the importance for health care practitioners to understand various challenges encountered by underserved Hispanic breast cancer patients due to COVID. Screening for psychological distress and exploring approaches to expand social support to address these challenges are discussed.
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Yang TC, Shoff C, Shaw BA, Strully K. Neighborhood characteristics and opioid use disorder among older Medicare beneficiaries: An examination of the role of the COVID-19 pandemic. Health Place 2023; 79:102941. [PMID: 36442317 DOI: 10.1016/j.healthplace.2022.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
This study investigates how the associations between residential characteristics and the risk of opioid user disorder (OUD) among older Medicare beneficiaries (age≥65) are altered by the COVID-19 pandemic. Applying matching techniques and multilevel modeling to the Medicare fee-for-service claims data, this study finds that county-level social isolation, concentrated disadvantage, and residential stability are significantly associated with OUD among older adults (N = 1,080,350) and that those living in counties with low levels of social isolation and residential stability experienced a heightened risk of OUD during the pandemic. The results suggest that the COVID-19 pandemic has aggravated the impacts of residential features on OUD.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA; Department of Epidemiology, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Benjamin A Shaw
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, Albany, NY, USA
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30
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Poghosyan H, Margaryan Y, Jeon S, Edelman EJ, Yu JB. Association between social connectedness and stress or anxiety among older cancer survivors during the 2020-2021 winter surge of the COVID-19 pandemic. J Geriatr Oncol 2023; 14:101390. [PMID: 36274031 PMCID: PMC9554341 DOI: 10.1016/j.jgo.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Our goal was to estimate a relative decreased rate of social connectedness to family and friends, increased rate of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic, and investigate the association between social connectedness and stress or anxiety among a nationally representative sample of older adults with cancer history. MATERIALS AND METHODS We used population-based, nationally representative cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 Community Supplement. The study cohort included community-living Medicare beneficiaries aged 65 years and older who self-reported cancer history (other than skin cancer) (n = 1650). Sample weights were applied to account for the complex survey design, with results generalizable to 8.5 million Medicare beneficiaries with cancer history. The outcome was self-reported feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. The independent variable was social connectedness, defined as feeling less socially connected to family and friends during the 2020-2021 winter surge of the COVID-19 pandemic. We conducted weighted descriptive statistics and multivariable logistic regression analyses. RESULTS Overall, 42.5% of beneficiaries reported decreased social connectedness to family and friends, and 37.8% reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. After adjusting for all covariates, participants who reported decreased social connectedness had 154% higher odds of increased feelings of stress or anxiety (adjusted odds ratio [AOD] = 2.54, 95% confidence interval [CI] = 2.00-3.20, p ≤0.001) compared to those who reported more or about the same social connectedness to family and friends. The odds of increased feelings of stress or anxiety were also higher for those who self-reported as Hispanic vs. non-Hispanic White beneficiaries (AOR = 1.35, 95% CI = 1.10-1.73, p = .016), women vs. men (AOR = 1.85, 95%CI = 1.43-2.38, p ≤0.001), and those who reported depression history vs. not reporting depression history (AOR = 2.55, 95% CI = 1.86-3.48, p ≤0.000). DISCUSSION An estimated 3.6 million older adults with cancer history reported decreased social connectedness to family and friends, and 3.2 million reported increased feelings of stress or anxiety during the 2020-2021 winter surge of the COVID-19 pandemic. Identifying these adults and referring them to appropriate supportive care resources and services are essential to help them cope with negative feelings.
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Affiliation(s)
- Hermine Poghosyan
- Yale School of Nursing, Yale University, New Haven, CT, USA; COPPER Center, Yale School of Medicine, New Haven, CT, USA.
| | | | - Sangchoon Jeon
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - E Jennifer Edelman
- Yale Schools of Medicine and Public Health, Yale University, New Haven, CT, USA
| | - James B Yu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY, United States of America
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Hanna JR, McConnell T, Harrison C, Patynowska KA, Finucane AM, Hudson B, Paradine S, McCullagh A, Reid J. 'There's something about admitting that you are lonely' - prevalence, impact and solutions to loneliness in terminal illness: An explanatory sequential multi-methods study. Palliat Med 2022; 36:1483-1492. [PMID: 36081273 PMCID: PMC9749015 DOI: 10.1177/02692163221122269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loneliness is a prevalent societal issue and can impact on a person's physical and mental health. It is unclear how loneliness impacts on end of life experiences or how such feelings can be alleviated. AIM To explore the perceived prevalence, impact and possible solutions to loneliness among people who are terminally ill and their carers in Northern Ireland through the lens of health and social care professionals. DESIGN An explanatory multi-method study. SETTING/PARTICIPANTS An online survey (n = 68, response rate 30%) followed by three online focus groups with palliative and end of life care health and social care professionals (n = 14). Data were analysed using descriptive statistics and thematic analysis. RESULTS Loneliness was perceived by professionals as highly prevalent for people with a terminal illness (92.6%) and their carers (86.8%). Loneliness was considered a taboo subject and impacts on symptoms including pain and breathlessness and overall wellbeing at end of life. Social support was viewed as central towards alleviating feelings of loneliness and promoting connectedness at end of life. Four themes were identified: (1) the stigma of loneliness, (2) COVID-19: The loneliness pandemic (3) impact of loneliness across physical and mental health domains and (4) the power of social networks. CONCLUSION There is a need for greater investment for social support initiatives to tackle experiences of loneliness at end of life. These services must be co-produced with people impacted by terminal illness to ensure they meet the needs of this population.
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Islam JY, Turner K, Saeb H, Powell M, Dean LT, Camacho-Rivera M. Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey. Front Public Health 2022; 10:946721. [PMID: 36483249 PMCID: PMC9723235 DOI: 10.3389/fpubh.2022.946721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years). Results Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44). Conclusion Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,*Correspondence: Jessica Y. Islam
| | - Kea Turner
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Huda Saeb
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Margaux Powell
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States,Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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Li J, Zhu S, Gao W. The psychological impact of COVID-19 among newly diagnosed patients with breast cancer when cancer care was returning to normal. Eur J Cancer Care (Engl) 2022; 31:e13762. [PMID: 36307937 PMCID: PMC9874744 DOI: 10.1111/ecc.13762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We aim to evaluate anxiety, depression and fear of cancer progression in newly diagnosed patients with breast cancer when cancer care was returning to normal after COVID-19 by comparing them with the pre-COVID patients and explore the association of worries about further cancer care and loneliness with them. METHODS Two hundred and eighteen newly diagnosed patients with breast cancer during the pandemic were surveyed using questionnaires, and 153 patients before the pandemic were included in the control group. Logistic regression analyses were used. RESULTS There were 51.8%, 44.0% and 30.7% of patients during the pandemic reported anxiety symptoms, depressive symptoms and clinically significant fear of cancer progression, respectively. The risks of anxiety symptoms (OR 2.24, 95% CI 1.43-3.51), depressive symptoms (1.61, 1.04-2.50) and clinically significant fear of cancer progression (4.65, 2.49-8.70) were higher in patients during the pandemic than pre-COVID patients. Worries about further cancer care and loneliness were associated with 1.40-2.52 times higher risks of these psychological problems among the patients during the pandemic. CONCLUSIONS The newly diagnosed patients with breast cancer during COVID-19 are at elevated risks of depression, anxiety and fear of cancer progression, and those who are worried about further cancer care and felt loneliness during the pandemic were more likely to experience psychological problems.
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Affiliation(s)
- Jie Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of MedicineShandong UniversityJinanChina,NHC Key Laboratory of Health Economics and Policy Research (Shandong University)JinanChina
| | - Songying Zhu
- Department of Breast Surgery, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Wei Gao
- Department of Breast Surgery, Qilu Hospital, Cheeloo College of MedicineShandong UniversityJinanChina
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Shah YB, Kjelstrom S, Martinez D, Leitenberger A, Manasseh D, Bollmann‐Jenkins M, Partridge A, Kaklamani V, Chlebowski R, Larson S, Weiss M. Risk factors for heightened COVID-19-Related anxiety among breast cancer patients. Cancer Med 2022; 12:3577-3588. [PMID: 36057956 PMCID: PMC9538212 DOI: 10.1002/cam4.5184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted medical care, increased isolation, and exacerbated anxiety in breast cancer patients. Since March 2020, Breastcancer.org experienced a sustained surge in requested pandemic-related information and support. To characterize the pandemic-related experiences of breast cancer patients, we surveyed the Breastcancer.org Community early in the COVID-19 era. METHODS Breastcancer.org Community members were invited to complete an online questionnaire regarding their experience during the pandemic. Self-reported data on demographics, comorbidities, care disruptions, anxiety, coping ability, telemedicine use, and satisfaction with care were collected. Results were analyzed using Stata 16.0 (Stata Corp., Inc). RESULTS Included were 568 current and previous breast cancer patients, primarily with U.S. residence. Overall, 43.8% reported at least one comorbidity associated with severe COVID-19 illness and 61.9% experienced care delays. Moderate to extreme anxiety about contracting COVID-19 was reported by 36.5%, increasing with number of comorbidities (33.0% vs. 55.4%, p = 0.021), current breast cancer diagnosis (30.4% vs. 42.5%, p = 0.011), and poorer coping ability (15.5% vs. 53.9%, p < 0.0001). Moderate to extreme anxiety about cancer care disruptions was reported by 29.1%, increasing with current breast cancer diagnosis (19.1% vs. 38.9%, p < 0.0001), actual delayed care (18.9% vs. 35.3%, p < 0.0001), and poorer coping ability (13.1% vs. 57.7%, p < 0.0001). Most utilized telehealth and found it helpful, but also expressed increased anxiety and subjectively expressed that these were less preferable. CONCLUSION Early in the COVID-19 pandemic, anxiety was reported by a large proportion of breast cancer patients, with increased prevalence in those with risk factors. Attention to mental health is critical, as emotional distress not only harms quality of life but may also compromise outcomes.
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Affiliation(s)
- Yash B. Shah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA,Breastcancer.orgArdmorePennsylvaniaUSA
| | - Stephanie Kjelstrom
- Main Line Health Center for Population Health ResearchLankenau Institute for Medical ResearchWynnewoodPennsylvaniaUSA,College of Population HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Diana Martinez
- Department of PsychiatryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | | | | | | | - Ann Partridge
- Department of Medical OncologyDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Rowen Chlebowski
- The Lundquist Institute, Harbor‐UCLA Medical CenterTorranceCaliforniaUSA
| | - Sharon Larson
- Main Line Health Center for Population Health ResearchLankenau Institute for Medical ResearchWynnewoodPennsylvaniaUSA,College of Population HealthThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Marisa Weiss
- Breastcancer.orgArdmorePennsylvaniaUSA,Radiation OncologyLankenau Medical CenterWynnewoodPennsylvaniaUSA
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Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 2022; 72:409-436. [PMID: 35736631 DOI: 10.3322/caac.21731] [Citation(s) in RCA: 937] [Impact Index Per Article: 468.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase in the United States due to the growth and aging of the population as well as advances in early detection and treatment. To assist the public health community in better serving these individuals, the American Cancer Society and the National Cancer Institute collaborate triennially to estimate cancer prevalence in the United States using incidence and survival data from the Surveillance, Epidemiology, and End Results cancer registries, vital statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics, and population projections from the US Census Bureau. Current treatment patterns based on information in the National Cancer Database are presented for the most prevalent cancer types by race, and cancer-related and treatment-related side-effects are also briefly described. More than 18 million Americans (8.3 million males and 9.7 million females) with a history of cancer were alive on January 1, 2022. The 3 most prevalent cancers are prostate (3,523,230), melanoma of the skin (760,640), and colon and rectum (726,450) among males and breast (4,055,770), uterine corpus (891,560), and thyroid (823,800) among females. More than one-half (53%) of survivors were diagnosed within the past 10 years, and two-thirds (67%) were aged 65 years or older. One of the largest racial disparities in treatment is for rectal cancer, for which 41% of Black patients with stage I disease receive proctectomy or proctocolectomy compared to 66% of White patients. Surgical receipt is also substantially lower among Black patients with non-small cell lung cancer, 49% for stages I-II and 16% for stage III versus 55% and 22% for White patients, respectively. These treatment disparities are exacerbated by the fact that Black patients continue to be less likely to be diagnosed with stage I disease than White patients for most cancers, with some of the largest disparities for female breast (53% vs 68%) and endometrial (59% vs 73%). Although there are a growing number of tools that can assist patients, caregivers, and clinicians in navigating the various phases of cancer survivorship, further evidence-based strategies and equitable access to available resources are needed to mitigate disparities for communities of color and optimize care for people with a history of cancer. CA Cancer J Clin. 2022;72:409-436.
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Affiliation(s)
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Theresa Devasia
- Data Analytics Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Angela B Mariotto
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Joan Kramer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, American Cancer Society, Atlanta, Georgia
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Calderon C, Lorenzo-Seva U, Ferrando PJ, Sorribes E, Rodríguez-González A, Obispo BM, Mihic-Góngora L, Corral MJ, Rogado J, Cruz-Castellanos P, Jiménez-Fonseca P. Measurement properties of the Spanish version of the brief resilient coping scale (BRCS) in cancer patients. Int J Clin Health Psychol 2022; 22:100313. [PMID: 35662793 PMCID: PMC9163688 DOI: 10.1016/j.ijchp.2022.100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 01/07/2023] Open
Abstract
Background/Objective Resilience is the capacity to adaptively confront stress. The aim of this study was to evaluate the psychometric properties, convergent validity, and factorial invariance of the Spanish version of the Brief Resilient Coping Scale (BRCS). Method Exploratory and confirmatory factor analyses based on a cross-validation were conducted to explore the scale's dimensionality and test for strong (scalar) measurement invariance across gender, age, tumor site, and survival, by fitting multiple-group confirmatory solutions. An extended structural equation model was used to assess external validity. Prospective, multicenter cohort study of 636 patients who completed the BRCS, Satisfaction with Life Scale (SWLS), and Spiritual well‐being (FACIT-sp) scales. Results The data supported a unidimensional structure. The BRCS is a very short, narrow bandwidth measure, with items demonstrating high discriminating power. A strong invariance solution demonstrated excellent fit across gender, age, tumor site, and survival. Scores derived from the unidimensional structure exhibited satisfactory degrees of reliability (ω = .86) and determinacy (FDI = .94). BRCS revealed substantial associations with satisfaction with life and spirituality well-being (all p < .001), factors widely related to resilience, particularly in cancer patients. Conclusions The Spanish version of the BRCS is a reliable, valid resilience measure in advanced cancer.
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Affiliation(s)
- Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Spain
- Corresponding author at: Department of Psychology, University of Barcelona, Barcelona, Spain.
| | - Urbano Lorenzo-Seva
- Department of Psychology, Faculty of Psychology, Rovira and Virgili University, Tarragona, Spain
| | - Pere J. Ferrando
- Department of Psychology, Faculty of Psychology, Rovira and Virgili University, Tarragona, Spain
| | - Elena Sorribes
- Department of Social Psychology and Quantitative, Faculty of Psychology, University of Barcelona, Spain
| | | | - Berta M. Obispo
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Luka Mihic-Góngora
- Department of Medical Oncology, Hospital Universitario Central of Asturias, Oviedo, Spain
| | - María J. Corral
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Spain
| | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central of Asturias, Oviedo, Spain
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Clifton K, Gao F, Jabbari J, Van Aman M, Dulle P, Hanson J, Wildes TM. Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic. J Geriatr Oncol 2022; 13:1122-1131. [PMID: 36041993 PMCID: PMC9385725 DOI: 10.1016/j.jgo.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/09/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022]
Abstract
Introduction The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic. Materials and methods A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions. Results In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition. Discussion Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.
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Affiliation(s)
- Katherine Clifton
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America.
| | - Feng Gao
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - JoAnn Jabbari
- Goldfarb School of Nursing at Barnes-Jewish College, Saint Louis, MO, United States of America
| | - Mary Van Aman
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Patricia Dulle
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Janice Hanson
- Washington University in Saint Louis School of Medicine, Saint Louis, MO, United States of America
| | - Tanya M Wildes
- Division of Hematology/Oncology, University of Nebraska Medical Center/Nebraska Medicine, Omaha NE, United States of America
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Sharma H, Pankratz VS, Demark-Wahnefried W, Pestak CR, Blair CK. Association between Quality of Life and Physical Functioning in a Gardening Intervention for Cancer Survivors. Healthcare (Basel) 2022; 10:1421. [PMID: 36011078 PMCID: PMC9407773 DOI: 10.3390/healthcare10081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine potential factors associated with maintaining or improving self-reported physical function (PF) among older cancer survivors participating in a gardening intervention impacted by the Coronavirus 2019 (COVID-19) pandemic. Methods: Thirty cancer survivors completed a home-based gardening intervention to encourage a healthier diet and a more active lifestyle. Device-based measures of physical activity (PA) and surveys to evaluate quality of life (QOL; PROMIS-57 questionnaire) were administered at baseline, mid-intervention (6 months), and post-intervention (9 months). Results: Depression, fatigue, and sleeplessness at baseline were significantly associated with worse average PF scores across follow-up (2.3 to 4.9 points lower for every decrease of 5 points in the QOL score; p-values < 0.02). Worsening of these QOL domains during the intervention was also associated with an additional decrease of 2.1 to 2.9 points in PF over follow-up (p values < 0.01). Better social participation and PA at baseline were significantly associated with better average PF scores during the intervention (2.8 to 5.2 points higher for every 5-point increase in social participation or 30 min more of PA; p values < 0.05). Every 5-point increase in pain at baseline, or increases in pain during the intervention, was associated with decreases of 4.9 and 3.0 points, respectively, in PF. Conclusions: Worse QOL scores before and during the intervention were significantly associated with worse PF over follow-up. Encouraging social participation and PA through interventions such as home-based gardening may improve long-term health among older cancer survivors.
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Affiliation(s)
- Harsh Sharma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
| | - Vernon S. Pankratz
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Claire R. Pestak
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
| | - Cindy K. Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA; (V.S.P.); (C.K.B.)
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM 87102, USA;
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Knight JM, Taylor MR, Rentscher KE, Henley EC, Uttley HA, Nelson AM, Turcotte LM, McAndrew NS, Amonoo HL, Mohanraj L, Kelly DL, Costanzo ES. Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients. Front Immunol 2022; 13:877558. [PMID: 35865530 PMCID: PMC9295749 DOI: 10.3389/fimmu.2022.877558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/01/2022] [Indexed: 01/13/2023] Open
Abstract
A growing body of literature has emphasized the importance of biobehavioral processes - defined as the interaction of behavior, psychology, socioenvironmental factors, and biological processes - for clinical outcomes among transplantation and cellular therapy (TCT) patients. TCT recipients are especially vulnerable to distress associated with pandemic conditions and represent a notably immunocompromised group at greater risk for SARS-CoV-2 infection with substantially worse outcomes. The summation of both the immunologic and psychologic vulnerability of TCT patients renders them particularly susceptible to adverse biobehavioral sequelae associated with the Covid-19 pandemic. Stress and adverse psychosocial factors alter neural and endocrine pathways through sympathetic nervous system and hypothalamic-pituitary-adrenal axis signaling that ultimately affect gene regulation in immune cells. Reciprocally, global inflammation and immune dysregulation related to TCT contribute to dysregulation of neuroendocrine and central nervous system function, resulting in the symptom profile of depression, fatigue, sleep disturbance, and cognitive dysfunction. In this article, we draw upon literature on immunology, psychology, neuroscience, hematology and oncology, Covid-19 pathophysiology, and TCT processes to discuss how they may intersect to influence TCT outcomes, with the goal of providing an overview of the significance of biobehavioral factors in understanding the relationship between Covid-19 and TCT, now and for the future. We discuss the roles of depression, anxiety, fatigue, sleep, social isolation and loneliness, and neurocognitive impairment, as well as specific implications for sub-populations of interest, including pediatrics, caregivers, and TCT donors. Finally, we address protective psychological processes that may optimize biobehavioral outcomes affected by Covid-19.
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Affiliation(s)
- Jennifer M. Knight
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States,Department of Microbiology & Immunology, Medical College of Wisconsin, Milwaukee, WI, United States,*Correspondence: Jennifer M. Knight,
| | - Mallory R. Taylor
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA, United States,Palliative Care and Resilience Program, Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Kelly E. Rentscher
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Elisabeth C. Henley
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hannah A. Uttley
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ashley M. Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, Boston, MA, United States
| | - Lucie M. Turcotte
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Natalie S. McAndrew
- College of Nursing, University of Wisconsin – Milwaukee, Milwaukee, WI, United States,Froedtert Hospital, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hermioni L. Amonoo
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States,Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Lathika Mohanraj
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, Richmond, VA, United States
| | - Debra Lynch Kelly
- Department of Nursing, University of Florida, Gainesville, FL, United States,Cancer Population Science, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, United States
| | - Erin S. Costanzo
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Hajjaji N, Lepoutre K, Lakhdar S, Bécourt S, Bellier C, Kaczmarek E, Broyelle A, Giscard S, Lartigau E. 16 Months Follow Up of Patients’ Behavior and Mild COVID-19 Patterns in a Large Cohort of Cancer Patients During the Pandemic. Front Oncol 2022; 12:901426. [PMID: 35747798 PMCID: PMC9209649 DOI: 10.3389/fonc.2022.901426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Acute severe forms of COVID-19 infection are more likely in cancer patients and growing attention has been given to the persistent symptoms of the disease after severe COVID-19. However, mild illness is the dominant clinical presentation of COVID-19 infection. To investigate patients’ behavior and the short- and longer-term pattern of the disease in cancer patients with mild COVID infection, a longitudinal online survey was conducted for 16 months during the pandemic in a large cohort of cancer patients from a French COVID-19 hot spot. An online questionnaire was administered at three time points between the first wave of the pandemic in France and the fourth wave. The questionnaire was completed by 1415 to 2224 patients, which queried patients’ demographics, their behavior, and COVID infection patterns. Seventy percent of the patients were female, and 40% had a comorbid condition. More than one-third of the participants had breast cancer, and half were survivors. The rate of infection was 30% during wave 1 and 10% in wave 4; most patients had a mild COVID-19 infection. Twenty-five percent of infected patients during wave 4 did not seek medical advice. At wave 4, 87% of the patients received at least one dose of vaccine. Systematic compliance to shielding measures decreased over time. The short-term pattern of mild COVID changed between wave 1 and wave 4. Twenty-two percent of infected patients experienced persistent signs for more than 6 months with a negative impact on sleep, social behavior, and increased consumption of stress-relieving drugs. Our results showed a high prevalence of long-lasting symptoms in cancer patients with mild COVID-19 infection and inadequate behavior toward the disease and prevention measures among patients.
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Affiliation(s)
- Nawale Hajjaji
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
- Inserm, U1192, Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), Univ. Lille, Lille, France
- *Correspondence: Nawale Hajjaji,
| | | | - Sarra Lakhdar
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
| | - Stéphanie Bécourt
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
| | - Charlotte Bellier
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
| | - Emilie Kaczmarek
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
| | - Antonin Broyelle
- Medical Oncology department, Oscar Lambret Cancer Center, Lille, France
| | | | - Eric Lartigau
- Radiotherapy department, Oscar Lambret Cancer Center, Lille, France
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Janah A, Haddy N, Demoor-Goldschmidt C, Bougas N, Clavel J, Poulalhon C, Lacour B, Souchard V, Jackson A, Casagranda L, Berger C, Allodji R, El Fayech C, Fresneau B, De Vathaire F, Dumas A. The Psychological Consequences of the COVID-19 Pandemic in Adults Treated for Childhood Cancer. Curr Oncol 2022; 29:4104-4116. [PMID: 35735436 PMCID: PMC9221954 DOI: 10.3390/curroncol29060327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Compared with the general population, childhood cancer survivors (CCS) could be at greater risk of psychological distress following the emergence of the COVID-19 pandemic. Purpose: This cross-sectional study assessed the psychological consequences of COVID-19 on the mental health of CCS. Design and participants: In December 2020, we interviewed through an online self-report questionnaire, 580 5-year CCS participating in the French Childhood Cancer Survivor Study (FCCSS) cohort. Methods: We first compared the mental health score of CCS with that observed in the French general population of the same age and gender. Subsequently, we studied predictors of the mental health score of CCS. Results: External comparisons revealed that the mental health score of CCS was similar to that of the general population. Among CCS, almost 42% stated that their psychological state had been worse during the lockdown. Predictors of poorer mental health included, among others, female gender, reporting a change in the occupational situation, having a relative who had been hospitalized or had died following COVID-19, and a greater perceived infection risk. Interpretation and Implications: Given the pre-existing vulnerability of some CCS to mental distress, the additional psychological consequences of COVID-19 in vulnerable survivors should receive attention from health care providers.
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Affiliation(s)
- Asmaa Janah
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Nadia Haddy
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- CHU Angers, Paediatric Oncology Department, F-49100 Angers, France
- François Baclesse Centre, Radiotherapy Department, F-14000 Caen, France
| | - Nicolas Bougas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
| | - Jacqueline Clavel
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Claire Poulalhon
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Brigitte Lacour
- Centre of Research in Epidemiology and Statistics, INSERM, F-94800 Villejuif, France; (J.C.); (C.P.); (B.L.)
- National Registry of Childhood Cancer, Paul Brousse Hospital (AP-HP), F-94800 Villejuif, France
- Regional University Hospital Centre of Nancy (CHRU Nancy), F-54511 Vandœuvre-lès-Nancy, France
| | - Vincent Souchard
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Angela Jackson
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Leonie Casagranda
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Claire Berger
- CHU St Etienne, Paediatric Oncology Department, F-42055 St Etienne, France; (L.C.); (C.B.)
- University of Lyon, University of Jean Monnet, INSERM, U 1059, F-42100 Saint-Étienne, France
| | - Rodrigue Allodji
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
| | - Chiraz El Fayech
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Gustave Roussy, Department of Children and Adolescents Oncology, F-94805 Villejuif, France
| | - Florent De Vathaire
- University of Paris-Saclay, F-94800 Villejuif, France; (N.H.); (C.D.-G.); (V.S.); (A.J.); (R.A.)
- Gustave Roussy, Department of Clinical Research, F-94800 Villejuif, France; (C.E.F.); (B.F.)
- INSERM U 1018, CESP, Radiation Epidemiology Team, F-94800 Villejuif, France
- Correspondence:
| | - Agnes Dumas
- Université Paris Cité, INSERM, ECEVE, F-75010 Paris, France; (A.J.); (N.B.); (A.D.)
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42
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Fasano GA, Bayard S, Bea VJ. Breast Cancer Disparities and the COVID-19 Pandemic. CURRENT BREAST CANCER REPORTS 2022; 14:192-198. [PMID: 36059579 PMCID: PMC9425818 DOI: 10.1007/s12609-022-00458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/07/2023]
Abstract
Purpose of Review The COVID-19 pandemic has placed unprecedented challenges on breast cancer patients and health care providers. The impact of the pandemic on preexisting breast cancer disparities remains unknown but is projected to have adverse outcomes. Recent Findings Early work has demonstrated that pandemic-related temporary suspensions in breast cancer screening, interruption of clinical trials, and treatment delays have an adverse impact on breast cancer patient outcomes and may worsen disparities. Summary In this review, we highlight existing knowledge regarding breast cancer disparities and the impact of the COVID-19 pandemic. Strategies for mitigating disparities moving forward include targeted research evaluating race-specific outcomes, targeted education for providers regarding breast health disparities, improved access to telehealth, maintenance of patient navigation programs, and patient education regarding the safety and necessity of enrollment in clinical trials.
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Affiliation(s)
- Genevieve A. Fasano
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA
| | - Solange Bayard
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA
| | - Vivian J. Bea
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA ,Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, NY 11215 USA
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43
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Kassianos AP, Georgiou A, Kyprianidou M, Lamnisos D, Ļubenko J, Presti G, Squatrito V, Constantinou M, Nicolaou C, Papacostas S, Aydin G, Chong YY, Chien WT, Cheng HY, Ruiz FJ, Garcia-Martin MB, Obando D, Segura-Vargas MA, Vasiliou VS, McHugh L, Höfer S, Baban A, Neto DD, da Silva AN, Monestès JL, Alvarez-Galvez J, Blarrina MP, Montesinos F, Salas SV, Őri D, Kleszcz B, Lappalainen R, Ivanović I, Gosar D, Dionne F, Merwin RM, Chatzittofis A, Konstantinou E, Economidou S, Gloster AT, Karekla M, Constantinidou A. Mental Health and Adherence to COVID-19 Protective Behaviors among Cancer Patients during the COVID-19 Pandemic: An International, Multinational Cross-Sectional Study. Cancers (Basel) 2021; 13:6294. [PMID: 34944913 PMCID: PMC8699048 DOI: 10.3390/cancers13246294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022] Open
Abstract
A population-based cross-sectional study was conducted during the first COVID-19 wave, to examine the impact of COVID-19 on mental health using an anonymous online survey, enrolling 9565 individuals in 78 countries. The current sub-study examined the impact of the pandemic and the associated lockdown measures on the mental health, and protective behaviors of cancer patients in comparison to non-cancer participants. Furthermore, 264 participants from 30 different countries reported being cancer patients. The median age was 51.5 years, 79.9% were female, and 28% had breast cancer. Cancer participants reported higher self-efficacy to follow recommended national guidelines regarding COVID-19 protective behaviors compared to non-cancer participants (p < 0.01). They were less stressed (p < 0.01), more psychologically flexible (p < 0.01), and had higher levels of positive affect compared to non-cancer participants. Amongst cancer participants, the majority (80.3%) reported COVID-19, not their cancer, as their priority during the first wave of the pandemic and females reported higher levels of stress compared to males. In conclusion, cancer participants appeared to have handled the unpredictable nature of the first wave of the pandemic efficiently, with a positive attitude towards an unknown and otherwise frightening situation. Larger, cancer population specific and longitudinal studies are warranted to ensure adequate medical and psychological care for cancer patients.
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Affiliation(s)
- Angelos P. Kassianos
- Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus; (A.P.K.); (M.K.)
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Alexandros Georgiou
- Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (A.G.); (E.K.); (S.E.)
| | - Maria Kyprianidou
- Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus; (A.P.K.); (M.K.)
| | - Demetris Lamnisos
- Department of Health Sciences, European University of Cyprus, Nicosia 2109, Cyprus;
| | - Jeļena Ļubenko
- Psychological Laboratory, Faculty of Public Health and Social Welfare, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Giovambattista Presti
- Human and Social Sciences Department, University of Enna Kore, 94100 Enna, Italy; (G.P.); (V.S.)
| | - Valeria Squatrito
- Human and Social Sciences Department, University of Enna Kore, 94100 Enna, Italy; (G.P.); (V.S.)
| | | | - Christiana Nicolaou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol 3041, Cyprus;
| | | | - Gökçen Aydin
- Department of Psychological Counseling and Guidance, Hasan Kalyoncu University, Gaziantep 27010, Turkey;
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Y.C.); (W.T.C.); (H.Y.C.)
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Y.C.); (W.T.C.); (H.Y.C.)
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; (Y.Y.C.); (W.T.C.); (H.Y.C.)
| | - Francisco J. Ruiz
- Department of Psychology, Universidad de La Sabana, Chia 140013, Colombia; (F.J.R.); (M.B.G.-M.); (D.O.); (M.A.S.-V.)
| | - Maria B. Garcia-Martin
- Department of Psychology, Universidad de La Sabana, Chia 140013, Colombia; (F.J.R.); (M.B.G.-M.); (D.O.); (M.A.S.-V.)
| | - Diana Obando
- Department of Psychology, Universidad de La Sabana, Chia 140013, Colombia; (F.J.R.); (M.B.G.-M.); (D.O.); (M.A.S.-V.)
| | - Miguel A. Segura-Vargas
- Department of Psychology, Universidad de La Sabana, Chia 140013, Colombia; (F.J.R.); (M.B.G.-M.); (D.O.); (M.A.S.-V.)
| | - Vasilis S. Vasiliou
- School of Applied Psychology, University College Cork (UCC), T23 XE10 Cork, Ireland;
| | - Louise McHugh
- School of Psychology, University College Dublin, D04 V1W8 Dublin 4, Ireland;
| | - Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, 400015 Cluj-Napoca, Romania;
| | - David Dias Neto
- ISPA—Instituto Universitário, 1149-041 Lisboa, Portugal;
- Applied Psychology Research Center Capabilities & Inclusion, 1149-041 Lisbon, Portugal
| | - Ana Nunes da Silva
- Department of Psychology, University of Lisbon, 1649-013 Lisbon, Portugal;
| | | | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, 11009 Cadiz, Spain;
| | | | - Francisco Montesinos
- Instituto ACT, 28049 Madrid, Spain; (M.P.B.); (F.M.)
- Department of Psychology, Universidad Europea de Madrid, 28049 Madrid, Spain
| | | | - Dorottya Őri
- Department of Mental Health, Heim Pal National Pediatric Institute, H-1089 Budapest, Hungary;
- Institute of Behavioral Sciences, Semmelweis University, H-1089 Budapest, Hungary
| | | | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, 40014 Jyväskylä, Finland;
| | - Iva Ivanović
- Department of Child Psychiatry, Institute for Children’s Diseases, Clinical Centre of Montenegro, 81000 Podgorica, Montenegro;
| | - David Gosar
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital Ljubljana, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia;
| | - Frederick Dionne
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Rhonda M. Merwin
- Department of Psychiatry and Behavioral Science, Duke University, Durham, NC 27708, USA;
| | | | | | - Sofia Economidou
- Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (A.G.); (E.K.); (S.E.)
| | - Andrew T. Gloster
- Division of Clinical Psychology & Intervention Science, Department of Psychology, University of Basel, 4055 Basel, Switzerland;
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus; (A.P.K.); (M.K.)
| | - Anastasia Constantinidou
- Bank of Cyprus Oncology Centre, Nicosia 2006, Cyprus; (A.G.); (E.K.); (S.E.)
- Medical School, University of Cyprus, Nicosia 1678, Cyprus;
- Cyprus Cancer Research Institute, Nicosia 2109, Cyprus
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44
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Rentscher KE, Zhou X, Small BJ, Cohen HJ, Dilawari AA, Patel SK, Bethea TN, Van Dyk KM, Nakamura ZM, Ahn J, Zhai W, Ahles TA, Jim HSL, McDonald BC, Saykin AJ, Root JC, Graham DMA, Carroll JE, Mandelblatt JS. Loneliness and mental health during the COVID-19 pandemic in older breast cancer survivors and noncancer controls. Cancer 2021; 127:3671-3679. [PMID: 34161601 PMCID: PMC8419003 DOI: 10.1002/cncr.33687] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/31/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has had wide‐ranging health effects and increased isolation. Older with cancer patients might be especially vulnerable to loneliness and poor mental health during the pandemic. Methods The authors included active participants enrolled in the longitudinal Thinking and Living With Cancer study of nonmetastatic breast cancer survivors aged 60 to 89 years (n = 262) and matched controls (n = 165) from 5 US regions. Participants completed questionnaires at parent study enrollment and then annually, including a web‐based or telephone COVID‐19 survey, between May 27 and September 11, 2020. Mixed‐effects models were used to examine changes in loneliness (a single item on the Center for Epidemiologic Studies–Depression [CES‐D] scale) from before to during the pandemic in survivors versus controls and to test survivor‐control differences in the associations between changes in loneliness and changes in mental health, including depression (CES‐D, excluding the loneliness item), anxiety (the State‐Trait Anxiety Inventory), and perceived stress (the Perceived Stress Scale). Models were adjusted for age, race, county COVID‐19 death rates, and time between assessments. Results Loneliness increased from before to during the pandemic (0.211; P = .001), with no survivor‐control differences. Increased loneliness was associated with worsening depression (3.958; P < .001) and anxiety (3.242; P < .001) symptoms and higher stress (1.172; P < .001) during the pandemic, also with no survivor‐control differences. Conclusions Cancer survivors reported changes in loneliness and mental health similar to those reported by women without cancer. However, both groups reported increased loneliness from before to during the pandemic that was related to worsening mental health, suggesting that screening for loneliness during medical care interactions will be important for identifying all older women at risk for adverse mental health effects of the pandemic. Older breast cancer survivors and matched noncancer controls experienced similar increases in loneliness from before to during the COVID‐19 pandemic. Women who reported increased loneliness also experienced worsening depression and anxiety symptoms and higher stress during the pandemic.
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Affiliation(s)
- Kelly E Rentscher
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Xingtao Zhou
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, Florida
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Asma A Dilawari
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Sunita K Patel
- Outcomes Division, Population Sciences, City of Hope National Medical Center, Los Angeles, California
| | - Traci N Bethea
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Kathleen M Van Dyk
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Zev M Nakamura
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Wanting Zhai
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deena M A Graham
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California.,Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jeanne S Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
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