Knowledge, attitudes and practices related to the COVID-19 outbreak among Romanian adults with cancer: a cross-sectional national survey

Systematic review and meta-analysis of knowledge, attitudes, and practices regarding COVID-19 among chronic disease patients: A global perspective

Background

Chronic health conditions were significantly correlated with an increased clinical severity of coronavirus 2019 (COVID-19) and a heightened risk of COVID-19 mortality. This study aims to determine global knowledge, attitudes, and practices (Knowledge Abuse Profile) of the patients with chronic diseases toward COVID-19.

Methods

The study was initiated in December 2019 and extended until April 2023, during which an extensive search for relevant English-language literature was conducted as part of this systematic review and meta-analysis. Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest were utilized for the search. The quality of included studies was assessed using a quality rating checklist created by Joanna Briggs Institute for cross-sectional research. In the STATA software version 14, inverse variance and Cochran Q statistics were used for statistical analysis to assess heterogeneity among the studies. The Dersimonian and Liard random-effects models were applied in cases where heterogeneity existed.

Results

A total of 23 studies involving 14,587 patients contributed to this meta-analysis. These studies comprised 21 studies focused on knowledge, with 6864 participants, 12 studies on attitudes involving 3597 patients, and 12 on practices, encompassing 4126 patients. The pooled estimates for sufficient knowledge, positive attitudes, and COVID-19 preventive behaviors among chronic disease patients were determined as 48.2% (95% confidence interval [95% CI]: 33.9%-62.5%), 60.8% (95% CI: 46.8%-74.8%), and 58.3% (95% CI: 39.5%-77.0%), respectively. Over the years, there was a consistent decrease in adequate knowledge, positive attitudes, and COVID-19 preventive behaviors among the population. Specifically, regarding knowledge, the rates declined from 50.2% in 2020 to 49.7% in 2021 and dropped to 45.1%. Similarly, the percentage of individuals with a positive attitude fell, decreasing from 64.1% in 2020 to 60.3% in 2021 and dropping to 57.9% in 2022. Furthermore, COVID-19 preventive behaviors showed fluctuations, with the rates recorded at 63.7% in 2020, increasing to 75.4% in 2021, and then decreasing to 47% in 2022, in line with the publication dates of included studies.

Conclusion

The findings of meta-analysis show a significant decrease in the levels of knowledge, attitudes, and adherence to preventative interventions for COVID-19 among individuals with chronic diseases. The findings emphasize the need for targeted interventions, and ongoing education to address this trend.

Evaluation of dietary supplementation and/or herbal food consumption habits and common beliefs on their effectiveness during the COVID-19 pandemic

Since 2020, COVID-19 has affected the entire world. Various dietary supplements/herbal foods are recommended to protect against and/or treat COVID-19 through social media and conventional media platforms, although their effects are unproven. Hence, this study aimed to investigate dietary supplementation and/or herbal food consumption habits intended to protect against and/or treat COVID-19, as well as common thoughts and beliefs about these products during the COVID-19 pandemic. This cross-sectional study was conducted as an online survey via the "SurveyMonkey" platform between June and December 2021. Participants were invited to participate in the study via social media (Instagram, Twitter, Facebook, WhatsApp) and the questionnaire was administered online. A total of 1767 participants were confirmed to be eligible. Overall, 35.3% used dietary supplements/herbal foods for protection against COVID-19 and 67.1% used them for treatment. Most believed that certain dietary supplements/herbal foods have an effect on the prevention and treatment of COVID-19. According to the COVID-19 infection status, participants differed in their opinions regarding the protective effects of vitamin D supplementation against COVID-19 (P = .02). It is important to raise public awareness of this issue and to avoid the unnecessary use of dietary supplements before sufficient evidence has been presented.

COVID-19 Knowledge, Attitudes, and Vaccine Hesitancy in Ethiopia: A Community-Based Cross-Sectional Study

The current healthcare system’s efforts to reduce the spread of COVID-19 in Ethiopia and limit its effects on human lives are being hampered by hesitancy toward the COVID-19 vaccine. The aim of this study was to assess the knowledge levels, attitudes, and prevention practices of COVID-19, in the context of the level of vaccine hesitancy with other associated factors in Ethiopia. A community-based cross-sectional design with mixed-method data sources was employed. It comprised 1361 study participants for the quantitative survey, with randomly selected study participants from the studied community. This was triangulated by a purposively selected sample of 47 key informant interviews and 12 focus group discussions. The study showed that 53.9%, 55.3%, and 44.5% of participants had comprehensive knowledge, attitudes, and practices regarding COVID-19 prevention and control, respectively. Similarly, 53.9% and 47.1% of study participants had adequate knowledge and favorable attitudes toward the COVID-19 vaccine. Only 29.0% of the total survey participants had been vaccinated with at least one dose of vaccine. Of the total study participants, 64.4% were hesitant about receiving the COVID-19 vaccination. The most frequently reported reasons were a lack of trust in the vaccine (21%), doubts regarding the long-term side effects (18.1%), and refusal on religious grounds (13.6%). After adjusting for other confounding factors, geographical living arrangements, the practices of COVID-19 prevention methods, attitudes about the vaccine, vaccination status, perceived community benefit, perceived barriers toward vaccination, and self-efficacy about receiving the vaccine were significantly associated with vaccine hesitancy. Therefore, to improve vaccine coverage and reduce this high level of hesitancy, there should be specifically designed, culturally tailored health education materials and a high level of engagement from politicians, religious leaders, and other community members.

Which type of fear of cancer progression contributes to the quality of life of Romanian cancer patients during the COVID-19 pandemic?

Introduction

Fear of cancer progression (FoP) is one of the most frequently reported unmet needs invoked by the majority of cancer patients, which may significantly impair the quality of life (QoL) of patients. The major objective of the present cross-sectional study was to investigate the specificities of the relationship between different dimensions and intensity of FoP and different aspects of patients' QoL during the COVID-19 pandemic in Romania.

Methods

A nationwide sample of 330 participants completed a survey, including measures of demographic characteristics, medical variables, QoL, and FoP. Multivariate General Linear and Hierarchical Regression Models were conducted in order to assess the relationship between variables.

Result

Our results indicate that less than a quarter of the sample experienced low, between 63 and 70% moderate, and 15% high levels of FoP. Our results also indicate that anxiety/worry related to the possibility of progression of the disease, and loss of independence produced significant differences with large effect sizes in all the dimensions of QoL.

Discussion

Our results indicate that besides affective reactions, the fear of cancer survivors to lose independence, not being able to attend to their own lives, seems to be a considerable threat, especially in the context of Romanian health system which has difficulties in offering qualitative psychosocial care for cancer patients. The idea that patients will have to rely on others and may not function well independently, not being able to attend to their own lives, seems to be a considerable threat, next to the experienced affective reactions per se.

SARS-CoV-2 Infection Anxiety, Knowledge and Attitudes in University Degree Pregnant Women from Romania-A Cross-Sectional Observational Survey in the First Two Pandemic Years

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a high economic cost, morbidity, and death toll. Due to high rates of mortality and morbidity from coronavirus disease 2019 (COVID-19), pregnant women were at particular risk during this pandemic. We designed and conducted a cross-sectional observational survey in Romanian pregnant women to evaluate the outcome of the SARS-CoV-2 pandemic along with the preventive measures taken by authorities. We applied a 43-item questionnaire. We included 147 women over 18 years old from Romania who were pregnant or gave birth between March 2020 and March 2022. All pregnancies were monitored, most of them by a gynecologist, and only 23% faced rescheduled pregnancy visits. The majority (84%) were screened through the TORCH panel, 95.91% felt anxious because of the pandemic, 87% followed SARS-CoV2 preventive recommendations, and 82% were not infected with the coronavirus. Additionally, 80% were vaccinated against COVID-19. They felt the consequences of the pandemic through anxiety, and their level of anxiety influenced their vaccination decisions, the TORCH testing and the method of giving birth despite the level of education. Fortunately, their pregnancies were monitored properly, and there were no consequences noticed for fetuses at birth.

COVID-19 vaccine acceptance and hesitancy among patients with cancer: a systematic review and meta-analysis

OBJECTIVES

Patients with cancer are more vulnerable to COVID-19 morbidity and morbidity than the general population and have been prioritised in COVID-19 vaccination programmes. This study aims to investigate COVID-19 vaccine acceptance and hesitancy among patients with cancer.

STUDY DESIGN

This was a systematic review and meta-analysis.

METHODS

PubMed, ScienceDirect and the Cochrane COVID-19 study registry were searched in addition to secondary literature using a predefined search method. Two authors independently performed the study identification, screening and eligibility assessment. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and Joanna Brides' Institute quality appraisal tools.

RESULTS

A total of 29 studies and reports were selected for the final review. The pooled prevalence of vaccine acceptance was 59% (95% confidence interval 52-67%, I2: 99%). Concerns about vaccine-related side-effects, uncertainty about vaccine efficacy and safety, ongoing active anticancer therapies and scepticism about rapid vaccine development were the leading causes for vaccine hesitancy. Female gender and undergoing active anticancer treatments were significant factors associated with COVID-19 vaccine hesitancy. Early cancer stages (stages I and II) and good compliance with prior influenza vaccinations were significant factors associated with the acceptance of the COVID-19 vaccine.

CONCLUSIONS

Many patients with cancer are hesitant about COVID-19 vaccination. Well-designed problem-based educational interventions will increase compliance with COVID-19 vaccination.

Factors Associated with Willingness to Receive a COVID-19 Vaccine in Adult Polish Population-A Cross-Sectional Survey

Vaccinations are proven to be the most efficient in preventing COVID-19 disease. Nonetheless, some people are skeptical and hesitant. The study aimed to determine factors associated with willingness to receive a COVID-19 vaccine in the Polish adult population. An online survey consisting of questions regarding (1) demographic information and (2) health issues (the status of vaccination, comorbidities, receiving the flu vaccine and usage of health monitoring apps) was distributed between 13 January and 14 February 2022. Of the 7018 participants who met the study conditions, 76.89% (n = 5396) were females, 22.44% (n = 1575) were males and 0.67% (n = 47) did not specify gender. The median age was 31 years. Among them, 81.82% (n = 5742) were vaccinated and 18.18% (n = 1276) were not. 46.87% (n = 3289) had no chronic co-morbidities. Factors associated with lower odds to receive the vaccine were: being men (p = 0.02; OR = 0.83), having lower education status (p = 0.001, OR = 0.56−0.77), living in a smaller residence area (p < 0.001, OR = 0.47−0.73.), not receiving flu vaccination (p < 0.001, OR = 24.51) and not using health monitoring applications (p < 0.001, OR = 1.56). Health education and communication strategies are needed to achieve large-scale vaccine acceptability and finally herd immunity.

Resilience as a Source of Easement to Health-Related Worries in Women at Increased Risk for Breast or Ovarian Cancer During the COVID-19 Pandemic

Purpose

The COVID-19 pandemic has affected individuals’ and society’s physical and psychological well-being. The study was conducted in order to assess the predictors for health-related worries during the COVID-19 pandemic in vulnerable populations.

Patients and Methods

A cross-sectional web-based survey of women who had a higher risk of developing breast cancer (BC) or ovarian cancer (OC) was conducted, regardless of whether they had experienced an active malignant disease during the pandemic. A self-reported questionnaire was designed for this study to assess health-related worries. The PHQ-4 questionnaire was used to evaluate mental health, and the Brief Resilience Scale (BRS) questionnaire was employed to investigate resilience.

Results

History of BC or OC was recognized as an independent significant risk factor for worries regarding being more susceptible to a more severe course of COVID-19 disease (OR 3.593; 95% CI 1.030–12.536; p = 0.045). High scores in the BRS questionnaire were negatively correlated with health-related worries, such as an increased risk for occurrence of BC or OC (OR 0.332; 95% CI 0.118–0.933; p = 0.37) or worsening of oncological outcome as a result of an infection with the SARS-CoV-2 virus (OR 0.330; 95% I 0.114–0.956; p = 0.041).

Conclusion

The obtained findings determined resilience as an independent and potent protective parameter in terms of health-related concerns in women at high risk for BC and OC. The results may assist in identifying women at risk for health-related concerns during adverse life events, allowing healthcare providers to respond fast and according to the patients´ needs.

From a voluntary vaccination policy to mandatory vaccination against COVID-19 in cancer patients: an empirical and interdisciplinary study in bioethics

BACKGROUND

At the start of 2021, oncologists lacked the necessary scientific knowledge to adapt their clinical practices optimally when faced with cancer patients refusing or reluctant to be vaccinated against COVID-19, despite the marked vulnerability of these patients to severe, and even fatal forms of this new viral infectious disease. Oncologists at Foch Hospital were confronted with this phenomenon, which was observed worldwide, in both the general population and the population of cancer patients.

METHODS

Between April and November 2021, the Ethics and Oncology Departments of Foch Hospital decided to investigate this subject, through an empirical and interdisciplinary study in bioethics. Our scientific objective was to try to identify and resolve the principal bio-ethical issues, with a view to improving clinical practices in oncology during future major pandemics of this kind, from a highly specific bio-ethical standpoint (= quality of life/survival). We used a mainly qualitative methodological approach based on questionnaires and interviews.

RESULTS

In April 2021, 29 cancer patients refused or were reluctant to be vaccinated (5.6%; 29/522). Seventeen of these patients said that making vaccination mandatory would have helped them to accept vaccination. In October 2021, only 10 cancer patients continued to maintain their refusal (1.9%; 10/522). One of the main reasons for the decrease in refusals was probably the introduction of the "pass sanitaire" (health pass) in July 2021, which rendered vaccination indispensable for many activities. However, even this was not sufficient to convince these 10 cancer patients.

CONCLUSION

We identified a key bio-ethical issue, which we then tried to resolve: vaccination policy. We characterized a major tension between "the recommendation of anti-COVID-19 vaccination" (a new clinical practice) and "free will" (a moral value), and the duty to "protect each other" (a moral standard). Mandatory vaccination, at least in France, could resolve this tension, with positive effects on quality of life (i.e. happiness), or survival, in cancer patients initially refusing or reluctant to be vaccinated, but only if collective and individual scales are clearly distinguished.

An update on the impact of SARS-CoV-2 pandemic public awareness on cancer patients' COVID-19 vaccine compliance: Outcomes and recommendations

Background:

Aside from the pandemic's negative health effects, the world was confronted with public confusion since proper communication and favorable decisions became an ongoing challenge. As a result, the public's perceptions were influenced by what they knew, the many sources of COVID-19 information, and how they interpreted it. With cancer patients continuing to oppose COVID-19 vaccines, we sought to investigate the COVID-19 pandemic and vaccine sources of this information in adult cancer patients, which either helped or prevented them from taking the vaccine. We also assessed the relevance and impact of their oncologists' recommendations in encouraging them to take the vaccine.

Methods

From June to October 2021, an online survey was conducted at King Hussein Cancer Center. A total of 441 adult cancer patients took part in the study. Patients who had granted their consent were requested to complete an online questionnaire, which was collected using the SurveyMonkey questionnaire online platform. Descriptive analysis was done for all variables. The association between categorical and continuous variables was assessed using the Pearson Chi-square and Fisher Exact.

Results

Our results showed that 75% of the patients registered for the COVID-19 vaccine, while 12% refused vaccination. The majority of participants acquired their information from news and television shows, whereas (138/441) got their information through World Health Organization websites. Because the SARS-CoV-2 vaccines were made in such a short period, 54.7 % assumed the vaccines were unsafe. Only 49% of the patients said their oncologists had informed them about the benefits of SARS-CoV-2 vaccines.

Conclusions

We found that SARS-CoV-2 vaccine hesitancy in cancer patients might be related to misinformation obtained from social media despite the availability of supportive scientific information on the vaccine's benefits from the physicians. To combat misleading and unreliable social media news, we recommend that physicians use telehealth technology to reach out to their patients in addition to their face-to-face consultation, which delivers comprehensive, clear, and high-quality digital services that guide and help patients to better understand the advantages of COVID-19 vaccines.

Knowledge, Attitude, and Perception of Cancer Patients towards COVID-19 in Pakistan: A Cross-Sectional Study

Background: Cancer patients, being immunocompromised, are at higher risk of coronavirus disease (COVID-19). The current study determines cancer patients’ knowledge, attitude, perception, and impact of the COVID-19 pandemic. Method: A cross-sectional online survey was conducted in Pakistan from 1 April 2020 to 1 May 2020. The study respondents were cancer patients with ages equal to or greater than 18 years. Following a request for participation, the URL for the survey was distributed on numerous channels. Other social media platforms, including WeChat, WhatsApp, Facebook, Twitter, Instagram, Messenger, and LinkedIn, were used to increase cancer patient interaction. The questionnaire comprised five different sections such as: (1) sociodemographic information, (2) knowledge, (3) attitude, (4) perception, and (5) impact of COVID-19 on cancer patients. Descriptive medical statistics such as frequency, percentage, mean, and standard deviation were used to illustrate the demographic characteristics of the study participants. To compare mean knowledge scores with selected demographic variables, independent sample t-tests and one-way analysis of variance (ANOVA) were used, which are also practical methods in epidemiological, public health and medical research. The cut-off point for statistical significance was set at a p-value of 0.05. Results: More than 300 cancer patients were invited, of which 208 agreed to take part. The response rate was 69.33% (208/300). Gender, marital status, and employment status had a significant association with knowledge scores. Of the total recruited participants, 96% (n = 200) (p < 0.01) knew about COVID-19, and 90% were aware of general symptoms of COVID-19 disease, such as route of transmission and preventive measurements. In total, 94.5% (n = 197) (p < 0.01) were willing to accept isolation if they were infected with COVID-19, and 98% (n = 204) (p < 0.01) had reduced their use of public transportation. More than 90% (n = 188) (p < 0.01) of cancer patients were found to be practicing preventative measures such as using a face mask, keeping social distance, and avoiding handshaking and hugging. Around 94.4% (n = 196) (p < 0.01) of cancer patients had been impacted by, stopped or had changed cancer treatment during this pandemic, resulting in COVID-related anxiety and depression. Conclusion: The included cancer patients exhibited a good level of COVID-19 knowledge, awareness, positive attitude, and perception. Large-scale studies and efforts are needed to raise COVID-19 awareness among less educated and high-risk populations. The present survey indicates that mass-level effective health education initiatives are required for developing countries to improve and reduce the gap between KAP and COVID-19.

Knowledge deficit and fear of COVID-19 among higher education students during the first wave of the pandemic and implications for public health: a multi-country cross-sectional survey

BACKGROUND

Public health measures such as physical distancing and distance learning have been implemented during the COVID-19 pandemic. COVID-19 related knowledge deficit can increase fear that leads to negative mental health and COVID-19, especially among adolescents. Therefore, our study aimed to assess COVID-19 related knowledge deficit and its association with fear among higher education (HE) students during the first wave of COVID-19.

METHODS

A cross-sectional survey, COVID-19 International Students Well-being Study (C-19 ISWS) was conducted in 133 Higher Education Institutions (HEIs) in 26 countries between April 27 and July 7, 2020. A stratified convenience sampling technique was used. Descriptive, bivariate, mixed-effect logistic regression analyses were conducted using R software.

RESULTS

Out of 127,362 respondents, 72.1% were female, and 76.5% did not report a previous history of confirmed COVID-19. The majority of those without the previous infection 81,645 (83.7%) were from 21 European countries while the rest 15,850 (16.3%) were from 5 non-European countries. The most frequent correct response to COVID-19 related knowledge questions among respondents was having the virus without having symptoms (94.3%). Compared to participants with good knowledge, the odds of being afraid of acquiring SARS-COV-2 infection among those with poor knowledge was 1.05 (95%CI:1.03,1.08) and the odds of being afraid of contracting severe COVID-19 was 1.36 (95%CI:1.31,1.40).

CONCLUSION

COVID-19 related knowledge was independently associated with both fear of acquiring SARS-COV-2 infection as well as contracting severe COVID-19. Our findings will serve as a basis for public health response for both the current and similar future pandemics by highlighting the need for addressing the COVID-19 knowledge deficit to fight the infodemic and prevent negative mental health outcomes.

Infection and reinfection with SARS-CoV-2 in cancer patients: A cohort study

COVID-19 reinfection, although a controversial issue, is an important clinical problem in cancer patients and beyond. The present study aimed to identify the risk factors associated with worse outcomes in cancer patients with Covid-19 in both first infection and reinfection and to describe the involvement of vaccines in reinfection outcome. The present study enrolled 85 patients with solid tumors who had Covid-19 infection and had not been previously vaccinated. Classical risk factors associated with worse outcomes in cancer patients with second SARS-Cov infection were considered. The patients were followed up retrospectively, measuring mortality at the first and second infection and the vaccination rate after the first infection. The factors associated with the highest risk of mortality at the first infection were, in order of importance: intensive care unit (ICU) admission, unfavorable performance status, radiologically quantifiable presence of oncological disease, and administration of cytotoxic chemotherapy in the period immediately before infection. The risk factors associated with higher mortality from reinfection were ECOG 3-4 performance status and administration of cytotoxic chemotherapy in the period immediately before infection. In the studied patients, mortality from reinfection was not affected by prior vaccination. Thus, bearing in mind all of these risk factors for poor outcomes in cancer patients with solid tumors presenting with Covid-19 can help the treating oncologists make personalized decisions about patient care during the pandemic.

Determinants of the Hesitancy toward COVID-19 Vaccination in Eastern European Countries and the Relationship with Health and Vaccine Literacy: A Literature Review

Herd immunity is necessary to control the coronavirus disease 2019 (COVID-19) pandemic. However, a low proportion of vaccinated people and low levels of vaccine acceptance have been noted in Eastern Europe. Our paper aimed to review the central attitudes associated with the hesitancy toward COVID-19 vaccination specific to Eastern European countries. The main Eastern European determinants of COVID-19 vaccine acceptance identified from the included studies are: public confidence in the vaccines’ safety and efficacy, vaccine literacy, and public trust in the government and the medical system. Each of these determinants is discussed along with possible improvement measures. Variables specific to Eastern Europe that predict the willingness to vaccinate have also been highlighted. The specific attitudes and their context as identified by our review should be incorporated into local public health programs, with the ultimate goal of reducing viral spreading, mutation emergence, and COVID-19 morbidity and mortality both within the borders of Eastern Europe and beyond.

On top of that all, now Covid-19, too. A scoping review of specificities and correlates of fear of cancer recurrence in breast cancer patients during COVID-19

Fear of cancer recurrence (FCR) is a normal response in cancer survivors and one of the most prevalent reactions reported by up to 87% of them. However, elevated levels of FCR impair well-being, quality of life and professional functioning, and lead to anxiety, depression or PTSD. COVID-19 pandemic can exacerbate FCR symptoms, given the restricting access to follow-up investigations and treatment, the isolation restrictions imposed and the possibility of the medical system becoming overworked. This scoping review's objective was to synthesize the literature investigating the factors associated with higher levels of FCR in cancer survivors during the COVID-19 pandemic. The focus was on FCR in breast cancer patients, including most of the studies (5 out of 9) on this topic. However, given the novelty of the subject, the increased interest in it, and the fact that there are few studies in this field, the review included 4 other studies with mixed samples of patients with breast cancer and other oncological pathologies. Following rigorous methodological criteria, 9 studies with quantitative or mixed methodology were included (N = 4831 patients). The results indicate that high levels of FCR are associated with distress and concerns regarding the pandemic impact, with most common concerns of patients being changes in treatment plan (delays and interruptions), dysfunctional communication with medical staff or difficult access to food or medicine. The most common correlates of FCR during the pandemic are marital status, childlessness, low financial status, level of education, type of cancer diagnosis, generalized anxiety and depression.

Counting the social, psychological, and economic costs of COVID-19 for cancer patients

PURPOSE

Cancer patients were particularly vulnerable to the adverse impacts of the COVID-19 pandemic given their reliance on the healthcare system, and their weakened immune systems. This systematic review examines the social, psychological, and economic impacts of COVID-19 on cancer patients.

METHODS

The systematic search, conducted in March 2021, captures the experience of COVID-19 Wave I, when the most severe restrictions were in place globally, from a patient perspective.

RESULTS

The search yielded 56 studies reporting on the economic, social, and psychological impacts of COVID-19. The economic burden associated with cancer for patients during the pandemic included direct and indirect costs with both objective (i.e. financial burden) and subjective elements (financial distress). The pandemic exasperated existing psychological strain and associated adverse outcomes including worry and fear (of COVID-19 and cancer prognosis); distress, anxiety, and depression; social isolation and loneliness. National and institutional public health guidelines to reduce COVID-19 transmission resulted in suspended cancer screening programmes, delayed diagnoses, postponed or deferred treatments, and altered treatment. These altered patients' decision making and health-seeking behaviours.

CONCLUSION

COVID-19 compounded the economic, social, and psychological impacts of cancer on patients owing to health system adjustments and reduction in economic activity. Identification of the impact of COVID-19 on cancer patients from a psychological, social, and economic perspective following the pandemic can inform the design of timely and appropriate interventions and supports, to deal with the backlog in cancer care and enhance recovery.

Acceptance of COVID-19 Vaccination and Its Associated Factors Among Cancer Patients Attending the Oncology Clinic of University Clinical Hospital Mostar, Bosnia and Herzegovina: A Cross-Sectional Study

Background

The pandemic of Coronavirus infectious disease 2019 (COVID-19) poses a major public health challenge, and an effective vaccine is the potential mechanism to resolve this specific situation. The present study aimed to evaluate acceptance of COVID-19 vaccination among patients attending the Oncology Clinic of University Clinical Hospital Mostar.

Material/Methods

This cross-sectional observational study enrolled 364 patients with cancer from the Oncology Clinic of University Clinical Hospital Mostar during February 2021. Data were collected using a questionnaire that captured general information about the participants and their attitudes toward COVID-19 vaccination.

Results

Of the participants, 41.8% answered “Yes” when asked if they would take the vaccine once it becomes available, 37.6% answered “Not sure”, and 20.6% answered “No”. For patients in favor of vaccination, the main reasons reported were fear of getting sick (77.6%), the desire to contribute to herd immunity (57.8%), and trusting the recommendations of health professionals (57.2%). The main reasons for the patients’ vaccination refusal/indecision were doubts about the results from clinical trials of COVID-19 vaccines (49.1%), concerns about adverse effects (24.5%), and confusion about the various vaccine options (19.8%). The majority of participants (82.4%) stated that recommendation by their oncologist could influence their decision about vaccination. Of the participants who indicated unwillingness (refusal or indecision) to be vaccinated against COVID-19, 65.3% stated that recommendation by their oncologist could influence their decision about vaccination.

Conclusions

The findings from the present study showed most patients had refused or were indecisive regarding immunization with COVID-19 vaccine. Increasing physician awareness of this situation may result in higher rates of vaccination.

Cancer Patients' Willingness to Take COVID-19 Vaccination: A Nationwide Multicenter Survey in Korea

Considering the high morbidity and mortality of Coronavirus disease 2019 (COVID-19) in patients with malignancy, they are regarded as a priority for COVID-19 vaccination. However, general vaccine uptake rates among cancer patients are known to be lower than in their healthy counterparts. Thus, we aimed to investigate the attitude and acceptance rates for the COVID-19 vaccine in cancer patients and identify predictive factors for vaccination that could be modified to increase vaccine uptake rates, via a paper-based survey (58 items over six domains). A total of 1001 cancer patients participated in this nationwide, multicenter survey between February and April 2021. We observed that 61.8% of respondents were willing to receive the COVID-19 vaccine. Positive predictive factors found to be independently associated with vaccination were male gender, older age, obesity, previous influenza vaccination history, absence of cancer recurrence, time since cancer diagnosis over 5 years, and higher EuroQol Visual Analogue Scale scores. Along with the well-known factors that are positively correlated with vaccination, here, we report that patients' disease status and current health status were also associated with their acceptance of the COVID-19 vaccination. Moreover, 91.2% of cancer patients were willing to be vaccinated if their attending physicians recommend it, indicating that almost 30% could change their decision upon physicians' recommendation. Unlike other factors, which are unmodifiable, physicians' recommendation is the single modifiable factor that could change patients' behavior. In conclusion, we firstly report that Korean cancer patients' acceptance rate of the COVID-19 vaccination was 61.8% and associated with disease status and current health status. Physicians should play a major role in aiding cancer patients' decision-making concerning COVID-19 vaccines.