1
|
Greteman BB, Del Vecchio NJ, Garcia‐Auguste CJ, Kahl AR, Gryzlak BM, Chrischilles EA, Charlton ME, Nash SH. Identifying predictors of COVID-related delays in cancer-specific medical care. Cancer Med 2024; 13:e7183. [PMID: 38629238 PMCID: PMC11022144 DOI: 10.1002/cam4.7183] [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: 10/16/2023] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Evidence of the impact of the COVID-19 pandemic on cancer prevention and control is growing, but little is known about patient-level factors associated with delayed care. We analyzed data from a survey focused on Iowan cancer patients' COVID-19 experiences in the early part of the pandemic. METHODS Participants were recruited from the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden (PERCH) program. We surveyed respondents on demographic characteristics, COVID-19 experiences and reactions, and delays in any cancer-related health care appointment, or cancer-related treatment appointments. Two-sided significance tests assessed differences in COVID-19 experiences and reactions between those who experienced delays and those who did not. RESULTS There were 780 respondents (26% response), with breast, prostate, kidney, skin, and colorectal cancers representing the majority of respondents. Delays in cancer care were reported by 29% of respondents. In multivariable-adjusted models, rural residents (OR 1.47; 95% CI 1.03, 2.11) and those experiencing feelings of isolation (OR 2.18; 95% CI 1.37, 3.47) were more likely to report any delay, where experiencing financial difficulties predicted delays in treatment appointments (OR 5.72; 95% CI 1.96, 16.67). Health insurance coverage and concern about the pandemic were not statistically significantly associated with delays. CONCLUSION These findings may inform cancer care delivery during periods of instability when treatment may be disrupted by informing clinicians about concerns that patients have during the treatment process. Future research should assess whether delays in cancer care impact long-term cancer outcomes and whether delays exacerbate existing disparities in cancer outcomes.
Collapse
Affiliation(s)
- Breanna B. Greteman
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | | | | | | | - Brian M. Gryzlak
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | | | - Mary E. Charlton
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Iowa Cancer RegistryUniversity of IowaIowa CityIowaUSA
| | - Sarah H. Nash
- Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- Iowa Cancer RegistryUniversity of IowaIowa CityIowaUSA
| |
Collapse
|
2
|
Yip KH, Yip YC, Tsui WK, Chan CSA, Mo YH, Smith GD. Navigating changes: A qualitative study exploring the health-related quality of life of breast cancer survivors during the coronavirus disease 2019 pandemic. J Adv Nurs 2024; 80:1531-1544. [PMID: 37902114 DOI: 10.1111/jan.15909] [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: 03/22/2023] [Revised: 09/04/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
AIMS To explore the impact of the coronavirus disease 2019 pandemic on the health-related quality of life (HRQoL) of breast cancer survivors. DESIGN We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years. METHODS Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic. RESULTS The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times. CONCLUSION This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL. IMPACT Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic. REPORTING METHOD The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized. PATIENT OR PUBLIC CONTRIBUTION A small selection on breast cancer survivors contributed to the design of this study, in particular the content of the semi-structured interviews.
Collapse
Affiliation(s)
- Ka-Huen Yip
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | - Yuk-Chiu Yip
- Hong Kong Institute of Paramedicine, Hong Kong, China
| | - Wai-King Tsui
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
| | | | - Yuen-Han Mo
- Department of Social Work, Hong Kong Shue Yan University, Hong Kong, China
| | | |
Collapse
|
3
|
Greteman BB, Garcia-Auguste CJ, Kahl AR, Gryzlak BM, Chrischilles EA, Charlton ME, Nash SH. Comparing COVID-19 Response Behaviors between a Cancer Patient Sample and a Population-Based Cancer-Free Sample in a Rural Midwestern State. Oncology 2023; 101:808-816. [PMID: 37579737 PMCID: PMC10842972 DOI: 10.1159/000533408] [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: 07/26/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION The COVID-19 pandemic caused an increase in fear, anxiety, and depressive symptoms globally. For populations at increased risk for adverse outcomes due to illness, such as cancer patients, these worries may have been exacerbated. Understanding how the pandemic impacted cancer patients will inform better preparation for future events that cause disturbances to cancer care delivery. METHODS This study analyzed data from two surveys to determine whether cancer patients' responses differed from a cancer-free population-based sample in terms of concerns, preventive behaviors, and thoughts on their healthcare provider's communication regarding COVID-19 in a US Midwestern state. In August 2020, a survey was sent to 10,009 Iowans aged 18 and older, randomly selected from the 2018 Iowa voter registration file. In September 2020, a survey was emailed to 2,954 cancer patients aged 18 and older who opted into the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden program. Previously validated and pretested Likert-type and multiple-choice items assessed concern regarding COVID-19, social distancing perception and behaviors, and demographic characteristics of respondents. We used χ2 tests and logistic regression to examine differences between the cancer patient and general population survey responses. RESULTS We included 3,622 responses from the general population survey and 780 responses from the cancer patient survey in this analysis. Cancer patient survey respondents were more frequently older, lived in urban areas, had Medicare insurance coverage, had a college degree or higher, and were married. Cancer patients were more likely to report engaging in social distancing behaviors and greater concern regarding the pandemic. CONCLUSION This study suggests differences in the impact of the COVID-19 pandemic on cancer patients compared to cancer-free members of the general population. These results indicate the need for consideration of cancer patients' physical and mental health during large-scale disruptions to cancer care.
Collapse
Affiliation(s)
- Breanna B. Greteman
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
| | - Crystal J. Garcia-Auguste
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
| | - Amanda R. Kahl
- Iowa Cancer Registry – State Health Registry of Iowa. 2600 UCC, University of Iowa. Iowa City, IA 52242, USA
| | - Brian M. Gryzlak
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
| | - Elizabeth A. Chrischilles
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
| | - Mary E. Charlton
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
- Iowa Cancer Registry – State Health Registry of Iowa. 2600 UCC, University of Iowa. Iowa City, IA 52242, USA
| | - Sarah H. Nash
- Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., S400 CPHB, Iowa City, IA 52242, USA
- Iowa Cancer Registry – State Health Registry of Iowa. 2600 UCC, University of Iowa. Iowa City, IA 52242, USA
| |
Collapse
|
4
|
Efficacy, safety, and molecular response predictors of oral ixazomib and short-course rituximab in untreated iNHL. Blood Adv 2023; 7:687-696. [PMID: 36385536 PMCID: PMC9984960 DOI: 10.1182/bloodadvances.2022008628] [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: 07/22/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022] Open
Abstract
Patients with indolent B-cell non-Hodgkin lymphoma (iNHL) generally require treatment but experience normal survival, emphasizing the need for simpler, safer therapies. Proteasome inhibitors target aberrant signaling pathways within iNHL and have manageable toxicities. We evaluated the oral proteasome inhibitor ixazomib as initial monotherapy, and combined with rituximab, for first-line treatment of iNHL. Treatment-naïve patients with iNHL needing therapy received oral ixazomib 4 mg weekly until progressive disease or unacceptable adverse events. A 4-week course of rituximab was added during month 7. The primary end point was overall response rate (ORR) during the ixazomib monotherapy window. Correlations included gene expression profiling and response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. Thirty-three patients with follicular lymphoma (FL) (n = 20), marginal zone lymphoma (n = 7), and other iNHL were treated with a median follow-up of 30.3 months. During the 6-month ixazomib window, the ORR was 24%, including 35% in FL. The best ORR over the entire study period was 52% overall and 65% in FL; complete response was achieved in 33% and 45%, respectively. The median duration of response was 25.8 months (range, 0-49.7), and the 24-month progression-free and overall survival rates were 51% (95% confidence interval [CI], 32-67) and 91% (95% CI, 74-97), respectively. Ixazomib was well tolerated. Baseline downregulation of proteasome genes, PSMB9 (P = .03) and PSMB8 (P = .007), were associated with response. All evaluated patients generated anti-S antibodies to SARS-CoV-2 vaccination, with a median of 254.9 binding arbitrary unit per mL. Ixazomib demonstrated efficacy alone and with short-course rituximab in untreated iNHL while exhibiting favorable toxicity, convenience, and retention of the B-cell immune response. This trial is registered at www.clinicaltrials.gov as NCT02339922.
Collapse
|
5
|
Ugas MA, Avery L, Wang Y, Berlin A, Giuliani ME, Krzyzanowska M, Papadakos TJ, Quartey NK(L, Samoil D, Papadakos JK. COVID-19 and Cancer Patients in the Second Year of the Pandemic: Investigating Treatment Impact, Information Sources, and COVID-19-Related Knowledge, Attitudes and Practices. Curr Oncol 2022; 29:8917-8936. [PMID: 36421354 PMCID: PMC9689213 DOI: 10.3390/curroncol29110701] [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: 10/08/2022] [Revised: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The novel coronavirus that has triggered the present COVID-19 pandemic continues to spread globally, resulting in widespread morbidity and mortality. Patients with cancer remain one of the most vulnerable subsets of the population to the disease. This study examined the effects of the pandemic on cancer patients' treatment, psychology, knowledge, attitudes, and practices. METHODS A survey was emailed to 9861 patients at a cancer centre in Toronto, Canada. Descriptive results were summarized. Qualitative feedback was coded and summarized. Regression modelling was used to explore factors associated with patient psychological well-being, knowledge, attitudes, and practices. RESULTS A total of 1760 surveys were completed, with a response rate of 17.8%. Most participants did not experience any pandemic-related treatment delays, and vaccination rates were high. Participants who identified themselves as non-white (OR 3.30, CI: 1.30-5.30; p ≤ 0.001), and those who referred to journal articles for information (p = 0.002) reported higher psychological impact scores. There were no significant predictors of whether participants would use personal protective equipment when leaving their homes or whether they would go to crowded places. DISCUSSION This study provides another snapshot of cancer patients perceptions and needs during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Mohamed A. Ugas
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Lisa Avery
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Yanning Wang
- Biostatistics Department, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Techna Institute, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Meredith E. Giuliani
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
| | - Monika Krzyzanowska
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
- Division of Medical Oncology, University of Toronto, Toronto, ON M5S 3H2, Canada
| | - Tina J. Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
| | - Naa Kwarley (Linda) Quartey
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Diana Samoil
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
| | - Janet K. Papadakos
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, Toronto, ON M5G 2N2, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, ON M5T 1V4, Canada
| |
Collapse
|
6
|
Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia. Curr Oncol 2022; 29:4199-4211. [PMID: 35735444 PMCID: PMC9222084 DOI: 10.3390/curroncol29060335] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/26/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Patients have had their cancer care either postponed or changed to telehealth visits to reduce exposure to COVID-19. However, it is unclear how these changes may have affected their experiences. We aim to identify patient characteristics that affect telehealth experiences and evaluate their preferences for using telehealth in the future. Methods: Patients who completed the Outpatient Cancer Care (OCC) Patient Experience Survey were invited to participate. They comepleted the modified OCC Survey, which focused on telehealth during the pandemic. Linear and logistic regression analyses were used to identify patient characteristics that influenced telehealth experiences and preferences for future telehealth use. Results: Perceived ease of participation in telehealth is a significant predictor of the change in patients’ ratings of their telehealth experience. We found that cancer patients had lower preferences for using telehealth in the future if they were older, female, or non-white; resided in an urban area; had no previous telehealth experience; had lower education; and had poorer mental health. Conclusions: To optimize cancer care and improve equitable access to high-quality telehealth care during the pandemic and beyond, clinicians and policymakers will need to consider patients’ self-reported experiences and their personal characteristics.
Collapse
|