The Effect of COVID-19 on Radiation Oncology Professionals and Patients With Cancer: From Trauma to Psychological Growth

Prospective assessment of anxiety among pediatric oncology patients and their caregivers during the COVID-19 pandemic a cohort study

To assess COVID-19-pandemic related anxiety and emotional-behavioral difficulties among oncologic children and their caregivers.

Prospective cohort study conducted from March to November 2020.

76 pediatric oncological and 28 nonmalignant hematological patients aged 1.6-23.4 years and their caregivers.

A total of 104 families completed an age-specific self-report psychological assessment; of these, 20 oncologic families completed the assessment at two time points.

Ten percent of the caregivers and 13.9% of the patients reported anxiety disorder. Additionally, 3.1% of the caregivers reported behavioral difficulties. No significant differences emerged between patients' self-reports and caregivers' reports. No differences emerged between oncological and nonmalignant hematological participants.

The prevalence of anxiety associated with the COVID-19 pandemic was similar to the reported prevalence of anxiety following a diagnosis of pediatric malignancy.

Real-time assessment of psychological effects revealed no COVID-19-associated anxiety. Nonetheless, late effects will need to be monitored.

Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives

Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.

Psychological impacts of COVID-19 pandemic in cancer patients on active treatment

Introduction

Although cancer patients have a high risk of exposing COVID-19 and developing severe complications, they have to receive active treatment. We aimed to determine the psychological conditions of cancer patients and shed light on the establishment of early psychological intervention and intervention policies by making specific recommendations.

Method

We consecutively evaluated 385 cancer patients under treatment. Post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, stress, and associated sociodemographic/clinical characteristics were investigated. In addition, we applied depression-anxiety-stress-scale-21 (DASS-21) for the mental states of patients and Impact of Event-Scale-Revised (IES-R) for the psychological effects of Covid-19.

Results

The mean age was 58 (18-88). 47.2% were psychologically distressful per DASS-21, and 39.3% were traumatic per IES-R scores. 71.9% stated the risk of getting COVID-19 was high since they had cancer, and 82% stated serious complications would develop if they had COVID-19 infection. Patients diagnosed for more than one year were more stressed, anxious, and depressive (p-value = 0.001,0.003,0.049, respectively). Singles were more stressed, depressed, and traumatized than couples (p-value = 0.001, 0.011, 0.001). In multivariate analysis, a significant correlation with being under psychiatric treatment before the pandemic was found for depression (OR: 3.743, 95 %CI: 1.790-7.827) anxiety (OR: 3.776-95 %CI: 1.945-7.332) and stress levels (OR: 4.129, 95 %CI: 1.728-9.866). Having relatives who died or received treatment for COVID-19(OR: 0.515,0.296-0.895) and being unmarried (OR: 2.445-95% CI: 1.260-4.747) predicts PTSD development.

Conclusions

When the psychological effects of the COVID-19 pandemic are manifesting strongly, cancer patients' anxiety and exposure levels are high. It is of great importance that clinicians understand needs, recognize psychological distress, and direct them to relevant departments for supportive care.

Post Traumatic Growth in Radiation Medicine following the COVID-19 Outbreak

Purpose

It has been reported that adversarial growth during traumatic events potentially enhances coping with sequelae. The purpose of this work was to assess posttraumatic growth (PTG) among radiation medicine staff members at the individual level as well as changes in perceptions of departmental culture after the COVID-19 pandemic.

Methods and Materials

An anonymous PTG inventory (PTGI) survey comprising 21 indicators was disseminated to all 213 members of our multicenter radiation department to measure perceptions of change in personal, interpersonal-relationship, and philosophy of life factors using principal-factor analysis. Additionally, 8 department safety-culture indicators from the National Hospital Patient Safety Culture Survey developed by the Agency for Healthcare Research and Quality were included to assess changes in department safety-culture perceptions verses a prepandemic survey. The survey was repeated 15 months later to assess longitudinal trends.

Results

With a 56.3% survey-response rate, PTGI factor analysis yielded Cronbach's alpha values exceeding 0.90 for the 3 aforementioned PTG factors. The average growth per indicator was 2.3 (out of 5.0), which fell between small and moderate. The values were 2.4 (personal), 2.1 (interpersonal), and 1.6 (philosophy) for the 3 factors. The total PTGI score (47.7 ± 28.3 out of 105 points) was lower for masked, patient-facing, frontline workers members (41.8 ± 28.4) compared with others (53.1 ± 27.3, P value .001). For the Agency for Healthcare Research and Quality survey there was an improvement of 15% in perceptions of department safety culture, and 7 of the 8 indicators showed improvements compared with baseline. The follow-up survey demonstrated overall sustained findings, albeit with a trend toward declining PTG scores for nonfrontline workers, notably in interpersonal relationships (47.4 ± 27.0, P value .05).

Conclusions

A fair-to-moderate degree of PTG was observed in personal and interpersonal relationship factors whereas least growth was noted in spiritual and religious beliefs. Perceptions of department patient-safety culture improved substantially. Sustained improvements were thus perceived at the individual and department levels.

Occupational burnout among radiation therapy technologists in Italy before and during COVID-19 pandemic

Introduction

Radiation therapy technologists (RTTs) are exposed to high stress levels which may lead to burnout, which could be further increased by the current pandemic. The aim of our study was to assess burnout and stress among Italian RTTs before and during the pandemic.

Methods

The Italian Association of Radiation Therapy and Medical Physics Technologists (AITRO) and the Italian Federation of Scientific Radiographers Societies (FASTeR) proposed a national online survey, including the Maslach Burnout Inventory assessing emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA) to RTTs before and during the pandemic. Multivariate regression analyses and χ² tests were used for data analysis.

Results

We obtained 367 answers, 246 before and 121 during the pandemic. RTTs before and during the pandemic showed high EE and DP, intermediate PA. Median EE was 37 (interquartile range [IQR] 31–46] before and 37 (IQR 30–43) during the pandemic, median DP was 16 (IQR 13–21) and 15 (IQR 12–20), respectively. PA was 31 (IQR 28–34) and 32 (IQR 28–34), respectively. Through multivariate analysis, being female and having children led to higher EE scores before and during the pandemic (p≤0.026). Only the presence of workplace stress management courses was related to lower DP before and being female was related to higher DP during the pandemic (p<0.001). Being female, having children, and working with paediatric patients were related to lower PA before and during the pandemic (p≤0.015).

Conclusion

Our study highlighted high burnout levels for RTTs regardless of the pandemic. Future interventions aimed at preventing burnout should be implemented in their work environment, independently of the impact of exceptional events.

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.

The Role of Healthcare Professionals' Passion in Predicting Secondary Traumatic Stress and Posttraumatic Growth in the Face of COVID-19: A Longitudinal Approach

COVID-19 has increased the likelihood of healthcare professionals suffering from Secondary Traumatic Stress (STS). However, the difficulty of this crisis may lead these professionals to display personal resources, such as harmonious passion, that could be involved in posttraumatic growth. The goal of this study is to examine the STS and posttraumatic growth among healthcare professionals and the demands and resources related to COVID-19. A longitudinal study was carried out in April 2020 (T1) and December 2020 (T2). The participants were 172 health professionals from different health institutions and they reported their workload, fear of contagion, lack of staff and personal protection equipment (PPE), harmonious passion, STS and posttraumatic growth. The results revealed that workload and fear of contagion in T2 were positive predictors for STS, whereas harmonious passion was a negative predictor. Fear of contagion of both times seemed to positively predict posttraumatic growth, as well as harmonious passion. One moderation effect was found concerning the lack of staff/PPE, as posttraumatic growth was higher when the workload was high, especially in those with a high lack of staff/PPE. All in all, these findings pointed out the need for preventative measures to protect these professionals from long-term negative consequences.

Stress-induced cognition among radiologic technologists in COVID-19 quarantine centres in Palestine

Background

The outbreak of COVID‐19 brought high mortality rate from the viral infection and caused a huge psychological stress for healthcare staff who work under great pressure during the pandemic.

Aims

The purpose of this study is to assess the level of stress‐induced cognition among radiologic technologists (RTs) in COVID‐19 quarantine centres in Palestine after the outbreak of COVID‐19.

Methods

Stress‐induced cognition was assessed using Stress‐induced Cognition Scale (SCS) questionnaire. The validity and stability of the measuring tool was verified. The sample consisted of 61 RTs who are working currently at various quarantine centres in Palestine.

Results

Cognition‐induced stress was higher than average. There was a statistically significant difference between RTs working directly with COVID‐19 patient compared with RTs working indirectly. Additionally, results show an increased level of stress for RTs having children compared with single or non‐parent RTs. Also, RTs who dealt with COVID‐19 patients for prolonged periods over a month had higher level of stress‐induced cognition. Other variables did not show significant differences among RTs.

Conclusion

It is recommended to provide psychological support for RTs who dealt and are currently involved in COVID‐19 quarantine centres to alleviate stress‐induced cognition.

Technology-based health solutions for cancer caregivers to better shoulder the impact of COVID-19: a systematic review protocol

BACKGROUND

Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19.

METHODS

A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process.

CONCLUSIONS

COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020196301.

Technology-based Health Solutions for Cancer Caregivers to Better Shoulder the Impact of COVID-19: A Systematic Review Protocol

BACKGROUND

Cancer patients are particularly vulnerable to COVID-19, partially owing to their compromised immune systems and curbed or cut cancer healthcare services caused by the pandemic. As a result, cancer caregivers may have to shoulder triple crises: the COVID-19 pandemic, pronounced healthcare needs from the patient, and elevated need for care from within. While technology-based health interventions have the potential to address unique challenges cancer caregivers face amid COVID-19, limited insights are available. Thus, to bridge this gap, we aim to identify technology-based interventions designed for cancer caregivers and report the characteristics and effects of these interventions concerning cancer caregivers' distinctive challenges amid COVID-19.

METHODS

A systematic search of the literature will be conducted in PubMed, PsycINFO, CINAHL, and Scopus from the database inception to the end of March, 2021. Articles that center on technology-based interventions for cancer caregivers will be included in the review. The search strategy will be developed in consultation with an academic librarian who is experienced in systematic review studies. Titles, abstracts, and full-text articles will be screened against eligibility criteria developed a priori. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process.

CONCLUSIONS

COVID-19 has upended cancer care as we know it. Findings of this study can shed light on evidence-based and practical solutions cancer caregivers can utilize to mitigate the unique challenges they face amid COVID-19. Furthermore, results of this study will also offer valuable insights for researchers who aim to develop interventions for cancer caregivers in the context of COVID-19. In addition, we also expect to be able to identify areas for improvement that need to be addressed in order for health experts to more adequately help cancer caregivers weather the storm of global health crises like COVID-19 and beyond.

STUDY PROTOCOL REGISTRATION

PROSPERO CRD42020196301.

Patients Living With Breast Cancer During the Coronavirus Pandemic: The Role of Family Resilience, Coping Flexibility, and Locus of Control on Affective Responses

The coronavirus disease 2019 (COVID-19) pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can mitigate the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic.

A Postcard From Italy: Challenges and Psychosocial Resources of Partners Living With and Without a Chronic Disease During COVID-19 Epidemic

The new Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). The sudden outbreak of this new virus and the measure of lockdown adopted to contain the epidemic have profoundly changed the lifestyles of the Italian population, with an impact on people's quality of life and on their social relationships. In particular, due to forced and prolonged cohabitation, couples may be subject to specific stressors during the epidemic. In addition, living with a chronic health condition may add specific challenges to the ones posed by the epidemic itself. The present cross-sectional study aimed to provide a picture of the challenges as well as the resources for both individual and relational well-being of Italian individuals in a couple relationship (N = 1921), with a specific attention to the comparison between individuals living with and without a chronic disease. Results showed that people with a chronic disease had lower psychological well-being and more fears and worries about the COVID-19. People with a chronic disease perceived fewer resources than healthy people. Moreover, the challenges are shown to be associated with less psychological well-being and high pessimism about the future. Instead individual, relational, and social resources play a protective role during the pandemic for both healthy and chronically ill people.

Pivots and pirouettes: adapting a robust departmental CPD and training program to the COVID-19 crisis

The onset of the COVID-19 pandemic caused swift change in society, affecting both personal and professional lives. In radiation therapy (RT), professional and social interactions are highly important to maintaining team culture and effective patient care. Continuing Professional Development (CPD) is also an integral part of maintaining professional and personal competence and growth for healthcare professionals. This article examines the rationale for and methods of swiftly adapting a robust CPD program and training calendar to an online offering for radiation therapists (RTs) at the Princess Alexandra Hospital Radiation Oncology Department, Brisbane, Australia. Reasons for the change, how it was achieved quickly, and the opportunity to build resilience in the staff group are discussed. Successes and challenges of achieving meaningful change in a short timeframe are described, ensuring RTs maintained access to both CPD and social support during the crisis. Initial feedback suggested a positive response from RTs, but the situation remains dynamic and will need to be monitored and adapted as the pandemic continues.

New York State and the Nation: Trends in Firearm Purchases and Firearm Violence During the COVID-19 Pandemic

BACKGROUND

The impacts of social stressors on violence during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We hypothesized that firearm purchases and violence would increase surrounding the pandemic. This study determined the impact of COVID-19 and shelter-in-place (SIP) orders on firearm purchases and incidents in the United States (US) and New York State (NYS).

METHODS

Scatterplots reflected trends in firearm purchases, incidents, and deaths over a 16-month period (January 2019 to April 2020). Bivariate comparisons of SIP and non-SIP jurisdictions before and after SIP (February 2020 vs. April 2020) and April 2020 vs. April 2019 were performed with the Mann-Whitney U test.

RESULTS

The incidence of COVID-19 in the US increased between February and April 2020 from 24 to 1 067 660 and in NYS from 0 to 304 372. When comparing February to March to April in the US, firearm purchases increased 33.6% then decreased 22.0%, whereas firearm incidents increased 12.2% then again increased by 3.6% and firearm deaths increased 23.8% then decreased in April by 3.8%. In NYS, comparing February to March to April 2020, firearm purchases increased 87.6% then decreased 54.8%, firearm incidents increased 110.1% then decreased 30.8%, and firearm deaths increased 57.1% then again increased by 6.1%. In both SIP and non-SIP jurisdictions, April 2020 firearm purchases, incidents, deaths, and injuries were similar to April 2019 and February 2020 (all P = NS).

DISCUSSION

Coronavirus disease 2019-related stressors may have triggered an increase in firearm purchases nationally and within NYS in March 2020. Firearm incidents also increased in NYS. SIP orders had no effect on firearm purchases and firearm violence.

The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities

Cancer is a leading cause of death in the United States and across the globe. Cancer screening is an effective preventive measure that can reduce cancer incidence and mortality. While cancer screening is integral to cancer control and prevention, due to the COVID-19 outbreak many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended health care services. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cancer screening. We present the challenges COVID-19 has exerted on patients, health care practitioners, and health systems as well as potential opportunities that could help address these challenges.

Traumatic Stress in Healthcare Workers During COVID-19 Pandemic: A Review of the Immediate Impact

The disease caused by respiratory syndrome coronavirus 2 (SARS-CoV-2) called COVID-19 resulted in a pandemic that has demanded extraordinary physical and mental effort from healthcare workers. This review provides an overview of studies that have explored traumatic stress in healthcare workers and associated factors between January and May 2020. The focus is on the most relevant literature investigating the prevalence of trauma- and stressor-related symptoms. Articles were selected from PubMed and PsycINFO databases using the search terms, "healthcare workers," "COVID-19," and "posttraumatic stress" in different combinations and with various synonyms. Among the seven studies that fulfilled our criteria, five assessed traumatic stress response, one assessed acute stress symptoms, and one focused on vicarious traumatization. Overall, the available findings highlight the presence of trauma-related stress, with a prevalence ranging from 7.4 to 35%, particularly among women, nurses, frontline workers, and in workers who experienced physical symptoms. Future studies should clarify the long-term effects of the COVID-19 pandemic on the mental health of healthcare workers, with particular focus on posttraumatic stress disorder.