Impact of the COVID-19 Pandemic on Patient-Reported Outcomes of Breast Cancer Patients and Survivors

Physiological Profile Assessment and Self-Measurement of Healthy Students through Remote Protocol during COVID-19 Lockdown

Background: The COVID-19 pandemic has led to reduced physical activity and increased sedentary behaviors, negatively impacting mental and physical health. Engaging in physical activity at home during quarantine became essential to counteracting these adverse effects. To develop appropriate physical activity programs, assessing individuals' fitness levels and the impact of inactivity is crucial. This study aims to compare motor abilities-including flexibility, balance, reaction time, cardiovascular endurance, and lower and upper limb strength-assessed both in-person and remotely, to determine the accuracy and repeatability of self-administered tests. Methods: A total of 35 young subjects (age 24.2 ± 1.97 years, BMI 22.4 ± 2.61 kg/m2) participated in this study. Each participant underwent a battery of motor ability tests designed to assess various fitness components. The tests were administered twice for each subject: once in a laboratory setting and once remotely at home. The sequence of tests was randomly assigned to ensure unbiased results. Both the in-person and remote assessments were used to evaluate the accuracy and reliability of self-administered tests. Results: The comparison of test results between the laboratory and remote settings revealed percentage differences ranging from 5% to 10%. This variation is considered an acceptable margin of error, suggesting that the tests conducted remotely were relatively accurate when compared to those performed in a controlled laboratory environment. Conclusions: The findings indicate that remote fitness testing is a promising method for evaluating motor abilities. With an acceptable margin of error, remote assessments can be effectively used to personalize training programs based on individuals' physiological characteristics. This approach may be particularly beneficial during times of limited access to fitness facilities, such as during quarantine, or for individuals seeking more flexible fitness evaluation methods.

The impact of the COVID-19 pandemic on symptomatic breast cancer presentations in an Irish breast cancer unit: a retrospective cohort study

BACKGROUND

The coronavirus-19 (COVID-19) pandemic caused delays in the diagnosis and management of breast cancer which may have affected disease presentation. The aim of this study was to compare rates of metastatic disease, tumour characteristics and management in breast cancer patients diagnosed before and after the onset of COVID-19.

METHODS

A retrospective chart review was conducted on patients in a university teaching hospital who were diagnosed with invasive symptomatic breast cancer in 2019 (prepandemic control group) and in 2020, 2021, and 2022 (pandemic study groups). Rates of new metastatic presentations, tumour histopathological characteristics, operation type, and therapies administered were statistically compared.

RESULTS

A total of 1416 patients were identified. There was a significant increase in new metastatic breast cancer presentations in 2022 compared to 2019 (14.0% vs 3.8%, p ≤ 0.001), with non-significant increases in 2020 and 2021. Rates of adjuvant radiotherapy increased in 2020 and decreased in 2022 compared to 2019, with no significant change in neoadjuvant or adjuvant chemotherapy rates. Rates of axillary surgery increased during 2020 and 2021. There was an increase in high-grade tumours and lymphovascular invasion (LVI), and less frequent oestrogen receptor (ER) positivity in pandemic groups. No significant change was noted in BCS to mastectomy ratios, overall nodal positivity rates, or median tumour size.

CONCLUSION

Symptomatic breast cancers diagnosed since the onset of COVID-19 demonstrated an increase in new metastatic presentations and more aggressive histopathological characteristics when compared to a pre-pandemic control group. Rates of adjuvant radiotherapy and axillary surgery increased during the pandemic.

Patient-reported outcomes in advanced NSCLC before and during the COVID-19 pandemic: Real-world data from the German prospective CRISP Registry (AIO-TRK-0315)

Patients with lung cancer under treatment have been associated with a high risk of COVID-19 infection and potentially worse outcome, but real-world data on patient-reported outcomes (PROs) are rare. We assess patients' characteristics and PROs before and during the COVID-19 pandemic in an advanced non-small cell lung cancer (NSCLC) cohort in Germany. Patients with locally advanced or metastatic NSCLC from the prospective, multicentre, observational CRISP Registry (NCT02622581) were categorised as pre-pandemic (March 2019 to Feb 2020, n = 1621) and pandemic (March 2020 to Feb 2021, n = 1317). From baseline to month 15, patients' health-related quality of life (HRQoL) was assessed by FACT-L, anxiety and depression by PHQ-4. Association of pandemic status with time to deterioration (TTD) in QoL scales adjusted for potential covariates was estimated using Cox modelling. PROs were documented for 1166 patients (72%) in the pre-pandemic, 979 (74%) in the pandemic group. Almost 60% of patients were male, median age was 66 years, comorbidities occurred in 85%. Regarding HRQoL, mean-change-from-baseline plots hardly differed between both samples. Approximately 15%-21% of patients reported anxiety, about 19%-27% signs of depression. For the pandemic group, TTD was slightly, but statistically significantly, worse for the physical well-being-FACT-G subscale (HR 1.15 [95%CI 1.02-1.30]) and the anxiety-GAD-2 subscale (HR 1.14 [95%CI 1.01-1.29]). These prospectively collected real-world data provide valuable insights into PROs before and during the COVID-19 pandemic in advanced NSCLC. For the patients, the pandemic seemed to be less of a burden than the disease itself, as there was a considerable proportion of patients with anxiety and depression in both groups.

COVID-19-Related Treatment Cancellations and Oncology Patients' Psychological Health in Nigeria

Objective: To explore the association between COVID-19-related cancer treatment cancellations and the psychological health of cancer patients in Nigeria.Methods: We analyzed data collected from 15 outpatient cancer clinics, comprising 1,097 patients between April to July 2020. Study outcome was ten psychological impacts, including feeling down, stressed, and unable to access treatment due to COVID-19 (used as continuous and categorical variable (0-3,4-7,8+ events). The independent variable was treatment cancellations due to COVID-19 categorized as 0, 1, and 2+ cancellations. Confounders included religion, ethnicity, income, cancer diagnosis/type, and treatment received. Stata/SE.v.17 was used to perform all analyses. P values of ≤0.05 were deemed statistically significant.Results: Of the 1,097 cancer patients, 65.7% were female, with a mean age (SD) of 49.4 (13.8) years. Most patients (50.3%) reported four to seven psychological health events. Cancer patients who reported two/more treatment cancellations made up only 12.8% of the study sample but accounted for a greater proportion of psychological impacts (23.5%; P<0.001). In the adjusted model, cancer patients with one treatment cancellation (Coef: 0.195, 95%CI: 0.089-0.302) and those with two/more cancellations (Coef: 0.379, 95%CI: 0.255-0.504) had a significantly higher risk of psychological health impacts than those with no treatment cancellations.Conclusion: More than half of our sample of primarily adult female cancer patients reported major psychological health effects due to COVID-19. Cancer patients who experienced at least one treatment cancellation had a higher risk of psychological health consequences than those who did not. The implications of our findings and how to mitigate the impact of COVID-19 on oncology service disruptions are discussed.

Sedentary time transitions and associations with quality of life in cancer survivors during the COVID-19 pandemic

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.

Cancer-related fatigue and activities of daily living: lessons learned from the COVID-19 pandemic

BACKGROUND

Cancer-related fatigue is a prevalent condition in all stages of oncologic disease that is poorly diagnosed, with a negative impact on physical function to perform activities of daily living. Fatigue is also one of the main manifestations in post-COVID-19 syndrome, and few studies have explored the functionality of cancer patients after infection by the new coronavirus. This study was designed to assess cancer-related fatigue symptoms and their implications on physical function and quality of life during the pandemic.

METHODOLOGY

An observational study with a cross-sectional survey in cancer patients ≥ 18 years of age was conducted. The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F), the perception of asthenia and performance status were evaluated, and the differences between groups according to the history of COVID-19 were calculated.

RESULTS

A total of 60 cancer patients had an average age of 33.5 ± 10.11 years, 73.3% were female, and 98.3% had an Eastern Cooperative Oncology Group-Performance Status level < 2. Severe fatigue was found in 43.3% of patients, and the average FACIT-F score was 33.5 ± 10.11. The proportion of coronavirus infection was 13,3%, and the performance of this group was worse on the scale compared to the group without infection (25 ± 10,40 vs. 34,81 ± 9,50 [p = 0,009]). There was a significant correlation between visual analog scale values and FACIT-F scale scores (Pearson's r = -0.76).

CONCLUSION

SARS-CoV-2 infection could increase cancer-related fatigue symptoms, limiting activities of daily living and impairing quality of life.

12-Month Trajectories of Health-Related Quality of Life Following Hospitalization in German Cancer Centers-A Secondary Data Analysis

Patient-reported outcomes (PROs) offer a diverse array of potential applications within medical research and clinical practice. In comparative research, they can serve as tools for delineating the trajectories of health-related quality of life (HRQoL) across various cancer types. We undertook a secondary data analysis of a cohort of 1498 hospitalized cancer patients from 13 German cancer centers. We assessed the Physical and Mental Component Scores (PCS and MCS) of the 12-Item Short-Form Health Survey at baseline (t0), 6 (t1), and 12 months (t2), using multivariable generalized linear regression models. At baseline, the mean PCS and MCS values for all cancer patients were 37.1 and 44.3 points, respectively. We observed a significant improvement in PCS at t2 and in MCS at t1. The most substantial and significant improvements were noted among patients with gynecological cancers. We found a number of significant differences between cancer types at baseline, t1, and t2, with skin cancer patients performing best across all time points and lung cancer patients performing the worst. MCS trajectories showed less pronounced changes and differences between cancer types. Comparative analyses of HRQoL scores across different cancer types may serve as a valuable tool for enhancing health literacy, both among the general public and among cancer patients themselves.

Sex-specific Impact of the first COVID-19 Lockdown on Age Structure and Case Acuity at Admission in a Patient Population in southwestern Germany: a retrospective comparative Study in Neuroradiology

OBJECTIVES

A hard lockdown was presumed to lead to delayed diagnosis and treatment of serious diseases, resulting in higher acuity at admission. This should be elaborated based on the estimated acuity of the cases, changes in findings during hospitalisation, age structure and biological sex.

DESIGN

Retrospective monocentric cross-sectional study.

SETTING

German Neuroradiology Department at a .

PARTICIPANTS

In 2019, n=1158 patients were admitted in contrast to n=884 during the first hard lockdown in 2020 (11th-13th week).

MAIN OUTCOME MEASURES

Three radiologists evaluated the initial case acuity, classified them into three groups (not acute, subacute and acute), and evaluated if there was a relevant clinical deterioration. The data analysis was conducted using non-parametric methods and multivariate regression analysis.

RESULTS

A 24% decrease in the number of examinations from 2019 to 2020 (p=0.025) was revealed. In women, the case acuity increased by 21% during the lockdown period (p=0.002). A 30% decrease in acute cases in men was observable (in women 5% decrease). Not acute cases decreased in both women and men (47%; 24%), while the subacute cases remained stable in men (0%) and decreased in women (28%). Regression analysis revealed the higher the age, the higher the acuity (p<0.001 in both sexes), particularly among women admitted during the lockdown period (p=0.006).

CONCLUSION

The lockdown led to a decrease in neuroradiological consultations, with delays in seeking medical care. In women, the number of most severe cases remained stable, whereas the mean case acuity and age increased. This could be due to greater pandemic-related anxiety among women, however, with severe symptoms they were seeking for medical help. In contrast in men, the absolute number of most severe cases decreased, whereas the mean acuity and age remained nearly unaffected. This could be attributable to a reduced willingness to seek for medical consultation.

How Did Breast Cancer Patients Fare during Different Phases of the COVID-19 Pandemic in Norway Compared to Age-Matched Controls?

Little is known about how health-related quality of life (HRQoL) in breast cancer cases differed from that of controls during and after the COVID-19 pandemic. This study used data from an ongoing, nationwide HRQoL survey of 4279 newly diagnosed breast cancer cases and 2911 controls to investigate how breast cancer patients fared during different phases of the pandemic compared to controls. Responders during 2020-2022 were categorized into three COVID-19-related phases: the social restrictions phase, the high infection rate phase, and the post-pandemic phase. Across phases, breast cancer cases had significantly worse scores in most HRQoL domains compared to controls. Apart from slightly more insomnia in the high infection rate phase for both cases and controls, and better social functioning for young cases in the post-COVID-19 phase, the case-control differences in HRQoL remained consistent across phases. When the phases were assessed as one period, young women and those living with children <18 years of age fared the worst among breast cancer cases, while single women fared the worst among controls. In contrast, controls living with children <18 years of age exhibited better HRQoL than controls without children. In summary, women with breast cancer did not appear to fare differently than controls in terms of HRQoL across COVID-19 phases. However, breast cancer cases with young children fared worse in their HRQoL than other breast cancer cases.

Impact of the Coronavirus Disease 2019 Pandemic on Medical Practices in Awaji Island

Introduction

Since the first confirmed case of coronavirus disease 2019 (COVID-19) in China, COVID-19 continues to be a global threat and exerts a significant impact on medical practices. This study aims to investigate the impact of the COVID-19 pandemic on medical practices in Awaji Island, a remote island in Japan.

Methods

First, we conducted a survey on the epidemiological characteristics of COVID-19 on Awaji Island before and during the pandemic. Next, using a questionnaire, we conducted a survey with doctors working full time at Hyogo Prefectural Awaji Medical Center, which is the only designated infectious disease hospital on Awaji Island.

Results

The COVID-19 infection rate of Awaji Island was lower than that of Hyogo Prefecture and of Japan as a whole, although the peaks occurred simultaneously. Outpatient visits as well as hospitalized patients, i.e., inpatients, decreased during the pandemic as a result of restrictions on surgeries and hospitalizations, with no changes in the disease composition ratio. The results of the questionnaire show that during the pandemic, doctors working full time at our hospital worked less and slept more. Furthermore, data obtained from the Medical Affairs Department showed a decrease in overtime hours worked and an increase in the number of days of paid holidays taken.

Conclusions

Epidemiologically, the impact of the COVID-19 pandemic on Awaji Island showed a similar trend to that in Japan, but the results of the survey questionnaire indicated that doctors working full time at our hospital were not necessarily adversely affected.

Mental Health Care Utilization and its Barriers among Iranian Breast Cancer Survivors: A Cross-sectional Study

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.

Mirror therapy effect on shoulder pain and disability and quality of life of mastectomy women: a randomized clinical trial

PURPOSE

To investigate mirror therapy (MT) influence on shoulder pain/disability and quality of life in mastectomy women.

MATERIALS AND METHODS

Sixty unilateral mastectomy women were recruited and randomly assigned to an MT group (N = 30) or a sham therapy (ST) (N = 30). Women in the MT and ST group attended a nurse-led, unsupervised, 30 min a day, five days a week, and at home training program for three weeks with and without a mirror, respectively. Shoulder pain and disability scale and QOL outcomes were assessed at baseline and 3 months after intervention.

RESULTS

Shoulder pain and disability were significantly improved in the MT group but there was not meaningful difference between groups in the EORTC-QOL scales except for some functional scores of QLQ-BR23 scale in the MT group after 3 months follow-up.

CONCLUSIONS

Nurses should instruct MT as a rehabilitation program to mastectomy patients during or after hospitalization to reduce their post-op shoulder pain and disability. This intervention may have also positive impact on their self-care outcomes. It is recommended that further studies should be performed with nurse-supervised exercises, a validated tool for measuring QOL for a long period after surgery, and a longer follow-up period at least for 6 months.Implication for rehabilitationThis study aimed to investigate whether an unsupervised, nurse-led mirror therapy (MT) can alleviate shoulder pain and disability of mastectomy patients and improve their quality of life.Our findings indicated that nurse-led MT as a novel rehabilitation option for mastectomy patients, may reduce shoulder pain and disability even after long period after the surgery.Rehabilitation centers can equip rooms for MT so breast cancer women can use it immediately after mastectomy.Mirror therapy can be used as a rehabilitation method for mastectomy patients because it is easy-to-use, inexpensive, and without the need to attend a rehabilitation center.Rehabilitation centers can provide mirrors along with nursing instructions to women who want to use this method at home.

Hand function and quality of life in patients with diabetes mellitus before and during the COVID-19 pandemic

This study aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on patients with diabetes mellitus using patient-rated outcome measures focusing on hand function and quality of life, as well as patients' mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. It was a part of a longitudinal research involving patients with diabetes mellitus living in Sapporo, Japan. Among the 594 patients surveyed before the COVID-19 pandemic from March to June 2019, 417 patients who could be re-surveyed from March to June 2021 were included. We compared the patient-rated outcome measures, namely the Hand10 for hand function and EuroQol five-dimension questionnaire for assessing quality of life in the same population of patients with diabetes mellitus, before and during the COVID-19 pandemic. The results indicated no deterioration in the Hand10 (3.9 vs 3.6) and quality of life scores (0.89 vs 0.9), including mobility (1.25 vs 1.17), self-care (1.1 vs 1.08), pain/discomfort (1.43 vs 1.35), and anxiety/depression (1.21 vs 1.2), during the COVID-19 pandemic when compared with the pre-pandemic values. Usual activity values on the EuroQol five-dimension subscale significantly improved during the pandemic compared to those before the pandemic (1.21 vs 1.12, p<0.01). This study highlighted the effects of the COVID-19 pandemic on patients with diabetes mellitus by comparing patient-rated outcome measures in two different social situations. Patients with diabetes mellitus living in Sapporo, Japan maintained hand function and quality of life by continuing their usual activities during the COVID-19 pandemic.

Health-related quality of life and patient-centred outcomes with COVID-19 vaccination in patients with breast cancer and gynaecological malignancies

Introduction

Safety and tolerability of COVID-19 vaccines were demonstrated by several clinical trials which led to the first FDA/EMA approvals in 2021. Because of mass immunizations, most social restrictions were waived with effects on quality of life. Therefore, our a-priori hypothesis was that COVID-19 vaccination impacted the health-related quality of life (HR-QoL) in patients with breast and gynecological cancer.

Methods

From March 15th until August 11th, 2022, fully vaccinated patients with breast and gynecological cancer treated in the oncological outpatient clinics of the Department of Obstetrics and Gynecology, LMU University Hospital, Munich, Germany filled out a vaccine related QoL survey. Patients were asked about demographics (age, comorbidities), clinical parameters related to previous COVID-19 infections, and HR-QoL related parameters (living situation, responsibilities in everyday life). Subsequently, a questionnaire with 12 items was designed using a 5-point Likert scale (0 - strongly disagree/4 - strongly agree), covering the aspects health and therapy, social environment, participation in everyday life and overall assessment.

Results

By August 11th, 2022, 108 out of 114 (94.7%) patients had received at least three doses of COVID-19 vaccine and six patients at least two doses. More than half of the surveyed patients were >55y (52.6%; mean: 55.1y, range 29-86y). Patients with breast cancer (n= 83) had early (59.0%) or metastatic cancer (41.0%); gynecological cancers (n=31) also included metastatic (54.8%) and non-metastatic cancer (45.2%). 83.3% of the patients stated that COVID-19 vaccination had a positive impact on their HR-QoL. Furthermore, 29 patients (25.4%) had undergone a COVID-19 infection. These patients reported self-limiting symptoms for a median duration of 5.9 days and no hospital admissions were registered.

Conclusions

Our study demonstrates that vaccination against COVID-19 was positively associated with HR-QoL in patients with breast and gynecological cancer. Furthermore, vaccinated patients who underwent COVID-19 disease experienced only self-limiting symptoms.

Postvaccine Era COVID-19 Pandemic-Related Distress in Palliative Care Patients With Advanced Cancer

CONTEXT

The COVID-19 pandemic represents a source of distress in patients with advanced cancer; however, few studies have examined the extent of pandemic-related distress in the postvaccine era.

OBJECTIVES

We conducted a cross-sectional survey to examine pandemic-related distress among patients seen by palliative care after vaccine availability.

METHODS

Patients at our palliative care clinic were surveyed from April 2021 to March 2022 regarding 1) pandemic-related distress level, 2) potential contributors to pandemic-related distress, 3) coping strategies, 4) demographic factors and symptom burden. Univariate and multivariate analyses identified factors associated with pandemic-related distress.

RESULTS

A total of 200 patients completed the survey. Of 79 (40%, 95% confidence interval [CI]: 33%, 46%) reported worse pandemic-related distress. Patients who reported greater distress were more likely to report worse social isolation (67 [86%] vs. 52 [43%]), staying home more often (75 [95%] vs. 95 [79%]), more negative experience staying at home (26 [33%] vs. 11 [9%]), worse stress with child-care duties (14 [19%] vs. 4 [3%]), less seeing family/friends (63 [81%] vs. 72 [60%]), and more difficulty traveling to medical appointments (27 [35%] vs. 20 [17%]). Thirty-seven patients (19%) reported more difficulty getting medical appointments. In multivariable analysis, younger age (odds ratio [OR], 0.97; 95% CI, 0.92-0.99; P = 0.01), worse isolation status (OR, 6.87; 95% CI, 2.76-17.12; P < 0.001), and more negative attitude towards staying home (OR, 4.49; 95% CI, 1.6-12.57; P = 0.004) were associated with pandemic-related distress.

CONCLUSIONS

Patients with advanced cancer continued to experience pandemic-related distress in the postvaccine era. Our findings highlight potential opportunities to support patients.

Perspectives of patients undergoing neoadjuvant chemotherapy for breast cancer during the COVID-19 pandemic

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.

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

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.

Ensuring access to post-cancer breast reconstructions: COVID-19 lessons from the Dutch Breast Implant Registry

BACKGROUND

COVID-19 has impacted breast implant surgery for oncological and non-oncological patients worldwide. This population-based study aimed to evaluate the impact of the COVID-19 pandemic on access to reconstructive and cosmetic breast implant surgery in the Netherlands using real-world data to describe trends, and to identify lessons to prevent future capacity problems within (inter)national healthcare.

METHODS

This longitudinal study included patients undergoing breast implant surgery from the mandatory nationwide Dutch Breast Implant Registry. For 2020, the first COVID-19 wave, intermediate period, and second wave were defined. We compared data from during the pandemic to a pre-pandemic (2019) reference year, assessing differences in the number of registered breast implants, and patient and surgery-related characteristics.

RESULTS

A total of 34133 breast implants (17459 patients) were included. Compared to 2019, fewer implants were registered for post-cancer (n=484; -14.7%), cosmetic (n=480; -3.6%), and gender-affirming indications (n=104; -38.0%) during 2020. Fewer implants were registered in academic (n=196; -22.0%) and regional hospitals (n=1591; -16.5%), but more in private clinics (n=725; +10.1%). After the first wave, up to twice as many implants were registered in private clinics compared to 2019. No differences were found in characteristics of patients undergoing surgery in 2020 versus 2019.

CONCLUSION

Hospital-based reconstructive and gender-affirming surgery were heavily impacted during the pandemic, while private-clinic-based cosmetic surgery quickly recovered. These outcomes are useful to fuel discussions about how healthcare could be reorganized in times of capacity problems. We suggest exploring options to deploy private clinics for ambulatory surgery aiming to keep hospital capacity available for acutely ill patients.

Changes in physical activity and associations with quality of life among a global sample of cancer survivors during the COVID-19 pandemic

PURPOSE

Meeting physical activity (PA) guidelines (i.e., ≥ 150 min/week of aerobic PA and/or 2 days/week of resistance training) is beneficial for maintaining cancer survivors' well-being. The impact of the COVID-19 pandemic on PA participation in cancer survivors and its association on quality of life (QoL) remains unknown. The purpose of this study was to compare PA levels prior to and during the COVID-19 pandemic, and examine the association between changes in PA and QoL in cancer survivors.

METHODS

A global sample of cancer survivors participated in a cross-sectional, online survey. Participants self-reported their PA participation before and during the pandemic using the Godin Leisure Time Exercise Questionnaire and QoL with the Functional Assessment of Cancer Therapy (FACT) scales. Paired t-tests compared PA before and during the pandemic. Analysis of covariance examined differences in QoL between PA categories: non-exercisers, inactive adopters, complete and partial relapsers, single and combined guideline maintainers.

RESULTS

PA participation of cancer survivors (N = 488) significantly decreased during the pandemic (p's < .001). Cancer survivors were classified as non-exercisers (37.7%), inactive adopters (6.6%), complete (13.1%) and partial (6.1%) relapsers, and single (23.8%) or combined (12.7%) guideline maintainers. Partial relapsers had significantly lower QoL and fatigue than inactive adopters, and combined guideline maintainers (p's < .05) that were clinically meaningful.

CONCLUSION

PA decreased during the pandemic which has negative implications for QoL and fatigue in cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

PA is critical for maintaining QoL during the pandemic; therefore, behavioral strategies are needed to help cancer survivors adopt and maintain PA.

Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes

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.

Depression, anxiety, & loneliness among cancer survivors during the COVID-19 pandemic

PURPOSE

To assess the impact of the COVID-19 pandemic on depression, anxiety, and loneliness between those with and without a history of cancer.

DESIGN

This prospective observational study used a quantitative approach.

PARTICIPANTS

Adult members of the Kaiser Permanente Research Bank (N = 104,640).

METHODS

Participants completed a series of surveys from May to December 2020. The difference in score of depression, anxiety, and loneliness were estimated using linear mixed regression.

FINDINGS

Among cancer survivors, 21% and 19% met the thresholds for increased risk of depression and anxiety. Among cancer survivors, younger age groups and females reported increased depression, anxiety, and loneliness scores.

CONCLUSIONS

This study highlights the continued necessity of addressing mental health needs and social support in cancer survivors during and after a public health emergency.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Cancer survivors may need particular resources after cancer treatment to strengthen resilience and improve quality of life.

Patient Experience and Clinical Outcomes after Same-day Outpatient Mastectomy and Immediate Breast Reconstruction Protocol during the Global Pandemic

The coronavirus disease 2019 (COVID-19) pandemic provoked rapid changes in clinical practice to accommodate mandated restrictions within healthcare delivery. This study reviewed patient-reported experiences and clinical outcomes after implementation of a same-day discharge protocol after mastectomy with immediate alloplastic breast reconstruction compared with our historical overnight stay protocol.

Methods

This is a retrospective single-institution study of consecutive patients who underwent mastectomy and immediate alloplastic reconstruction between July 2019 and November 2020. A postoperative survey was completed by patients to evaluate satisfaction with perioperative communications, recovery, and their overall experience.

Results

A total of 302 patients (100% women) underwent mastectomy and immediate alloplastic reconstruction (174 pre-COVID-19, 128 during COVID-19). During COVID-19, 71% of patients were scheduled for a same-day discharge, among which 89% were successfully discharged the same day. Compared with pre-COVID-19, there were no differences in type of surgery, operative times, pain scores, 30-day readmission, or unplanned visits (all P > 0.05) during the COVID-19 pandemic. Compared with pre-COVID-19, patients during the pandemic reported comparable satisfaction with their care experience and postoperative recovery (56% survey response rate). Patient satisfaction was also similar between those discharged the same day (n = 81) versus the next day (n = 47) during COVID-19.

Conclusions

Same-day discharge is feasible, safe, and can provide similar patient-reported satisfaction and outcomes compared with traditional overnight stay. These data highlight the ability to deliver adaptable, high-quality breast cancer care, within the constraints of a global pandemic.

Quality of life and emotional distress in sarcoma patients diagnosed during COVID-19 pandemic: a supplementary analysis from the SarCorD study

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.

The impact of COVID-19 on the interpretation of psycho-oncological support trial results: a quasi-experimental approach using the data from the new form of care "Integrated cross-sectoral psycho-oncology (nFC-isPO)"

OBJECTIVE

In addition to the common difficulties of ongoing trials, the COVID-19 pandemic posed several challenges to scientists worldwide and created an additional burden for vulnerable patient groups. In the nFC-isPO of individualised treatment for anxiety and depression in newly diagnosed patients with cancer caregivers (e.g. psycho-oncologists) reported elevated HADS scores in newly enrolled patients after the outbreak of the COVID-19 pandemic. Accordingly, the question arises whether the pandemic affected HADS scores. Therefore, stratified analyses by the time of enrolment (T1) were performed for patients with 12 months of care (T3).

METHODS

Patients with 12 months of care (N = 1,140) were analysed. A comparison within the regression discontinuity design according to the time points at which patients completed the baseline (T1) HADS questionnaire was conducted to examine differences between patients recruited before Q2/2020 (pre-pandemic) and after the coronavirus outbreak. Furthermore, mean HADS scores at T1 and T3 for all quarters during the study were compared.

RESULTS

Mean T1 and T3 HADS scores of patients with cancer during the pandemic are only slightly higher than those of the pre-pandemic group. No significant treatment effect was observed in either the pre-pandemic (p = 0.5495, Late = 1.7711) or the post-pandemic group (p = 0.9098, LATE=-0.2933). In contrast, the average local treatment effect in the post-pandemic group suggests a minimal decrease in HADS score in the predefined range and thus a positive treatment effect for isPO. Comparison of mean HADS scores at T1 and T3 did not show a large increase by pandemic-related timepoints, however, a decrease of approximately 2-3 points over each quarter at 12 months compared to baseline is observed.

CONCLUSION

The existing nFC-isPO care is resilient to crisis and may counteract external influences such as the Corona pandemic. Accordingly, the pandemic had little influence on the fears of patients with cancer in the nFC-isPO. This emphasises that psycho-oncology is vital for the reduction of stress, anxiety and depression in patients with cancer.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Registry on 30 October 2018 under the ID "DRKS00015326".

Characteristics and influencing factors of social isolation in patients with breast cancer: a latent profile analysis

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.

Physical and mental health of breast cancer patients and survivors before and during successive SARS-CoV-2-infection waves

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.

Perceptions of burnout in medical dosimetry within a postpandemic work environment

According to the World Health Organization, burnout is described as having a negative attitude regarding one's work and being exhausted. Previous studies have shown that occupational burnout exists amongst medical dosimetrists, however, the incidence of medical dosimetrist burnout before and after a pandemic warrant continued research. Medical dosimetrists could be experiencing increased burnout in the workplace postpandemic due to staffing shortages and increased remote planning, which may reduce work performance. The researchers utilized a survey to answer research questions regarding whether staffing shortages or remote planning influenced perceived occupational burnout among medical dosimetrists in a post COVID-19 pandemic environment. The survey was intended to assess levels of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA). It was distributed electronically to 2591 certified medical dosimetrists in the United States through the American Association of Medical Dosimetrists (AAMD) membership database. A total of 160 responses were recorded, resulting in a response rate of 6% (160/2591). The results of this study indicated that increased staffing shortages have a direct relationship with increased burnout incidence. Increased remote work appears to be inversely related to the incidence of burnout among medical dosimetrists.

Use of Online Health Forums by People Living With Breast Cancer During the COVID-19 Pandemic: Thematic Analysis

BACKGROUND

At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time.

OBJECTIVE

This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic.

METHODS

This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum's boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived.

RESULTS

We found that COVID-19 amplified the forum's value to its users. As patients with cancer, participants were in a situation that was "bad enough already," and the COVID-19 pandemic heightened this difficult situation. The forum's value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users' spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards-most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation.

CONCLUSIONS

The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support.

Use of patient-reported outcomes in heart failure: from clinical trials to routine practice

Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.

Influence of the COVID-19 pandemic on self-reported urinary incontinence during pregnancy and postpartum: A prospective study

OBJECTIVE

To explore how the COVID-19 pandemic influenced self-reported occurrence and severity of pregnancy-related urinary incontinence (UI) in the maternity pathways of Tuscany, Italy.

METHODS

In this prospective pre-post cohort study, we selected a pre-pandemic (n = 1018) and a post-pandemic (n = 3911) cohorts of women that completed, from the first trimester until 3 months postpartum, three surveys including validated patient-reported outcome measures for UI. Data were obtained from systematic surveys on the maternity pathways of Tuscany from March 2019 to June 2021. We performed panel regression models to explore how UI risk differed between COVID-19 groups.

RESULTS

UI occurred less frequently and less severely in post-pandemic patients-especially stress/mixed UI in women never performing pelvic floor muscle training (PFMT)-whereas no difference emerged in women performing during-pregnancy PFMT. During COVID-19, obese women had higher risk of UI, whereas women undergoing operative delivery had lower risk. The post-pandemic group reported more severe UI symptoms at the third trimester, but less severe UI postpartum in women suffering from UI during pregnancy.

CONCLUSIONS

During the COVID-19 pandemic, women reported fewer UI symptoms because they might have lacked chances to identify UI symptoms as a result of pandemic-related sedentarism and inactivity. The risk in women performing during-pregnancy PFMT was not increased, but just six of 26 health districts organized remote PFMT sessions, thus revealing limited resilience to the pandemic in Tuscany.

Development of a novel patient-reported outcome measure to assess signs and symptoms of COVID-19

Background

Given the urgent need for vaccines and treatments for coronavirus disease 2019 (COVID-19), the Symptoms of Infection with Coronavirus-19 (SIC), a comprehensive, patient-reported outcome (PRO) measure of signs and symptoms associated with COVID-19, was developed in full alignment with current US regulatory guidance to support evaluations of vaccines and treatments in development.

Methods

An initial version of the SIC was developed to address concepts identified through a targeted literature review and consultation with experts in infectious diseases and clinicians routinely managing COVID-19 in a hospital setting. A qualitative study was conducted in sites in the United States among 31 participants aged ≥ 18 years who were English-speaking and willing and able to provide informed consent and a self-reported history by telephone or online method. The measure was refined based on additional feedback from the clinicians and three iterative rounds of combined concept elicitation and cognitive debriefing interviews conducted with patients, caregivers, and healthy volunteers.

Results

Among 39 scientific articles identified in the literature review, 35 COVID-19 signs and symptoms were reported and confirmed during interviews with clinicians, patients, and caregivers. Patients and healthy participants suggested changes for refining the draft SIC to ensure consistent interpretation and endorsed both the 24-h recall period and use of an 11-point numeric rating scale (NRS) for capturing change in symptom severity. The final version of the SIC captures the daily presence or absence of 30 symptoms and a rating of severity for 25 of the 30 symptoms using an NRS for those symptoms reported as present.

Conclusions

The SIC comprehensively addresses observations described in the literature, by clinicians, and by patients, and captures patients’ experiences with COVID-19 in a manner that minimizes complexity and facilitates completion for both patients and healthy volunteers. This measure is thus appropriate for use in clinical trials of both therapeutics and vaccines for COVID-19.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-022-00471-w.

The psychological impact of COVID-19 among newly diagnosed patients with breast cancer when cancer care was returning to normal

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.

Impacts of the Early COVID-19 Pandemic Among a National Sample of Adolescent and Young Adult Cancer Survivors in the United States

Purpose: Adolescent and young adult cancer survivors (AYAs) experience early-onset chronic conditions and disrupted psychosocial development. We report prevalence of disruptions in care delivery and social support during the early wave of the pandemic in a national sample of AYAs in the United States. Materials and Methods: We used data from the population-based National Health Interview Survey (NHIS; July-December 2020), which allows for nationally representative estimates, and included questions related to COVID-19. We identified 61 AYAs diagnosed with cancer between ages 15 and 39 years and not currently receiving cancer treatment and 244 age- and sex-matched controls. We compared the proportion of AYAs and controls reporting delayed care due to the pandemic, not getting needed care due to the pandemic, and changes in social and emotional support. Results: AYAs were predominantly non-Hispanic White (61.3%) and female (58.8%), with a median age at diagnosis of 28 years (interquartile range [IQR] 21-31 years). Fewer AYAs were employed (52.1% vs. 71.5%), and more lived in poverty (32.0% vs. 12.4%) and felt depressed daily (9.9% vs. 3.0%, all p < 0.05). The proportion of AYAs reporting delayed care (39.8% vs. 15.3%) and not getting needed care (31.7% vs. 10.4%) due to the pandemic was more than double that of controls (both p < 0.01). One in five AYAs experienced less social and emotional support compared to the prior year, although not significantly different from controls (21.6% vs. 12.4%, p = 0.10). Conclusions: The pandemic disrupted AYAs' care and exacerbated their psychosocial challenges. Providers and health systems should prioritize reconnecting AYAs to affordable and comprehensive care.

Impact of the COVID-19 pandemic on nurses mental health status in Iraq

BACKGROUND

The COVID-19 pandemic is a major health crisis that has changed the life of millions globally. Coronaviruses are viruses' group that can contract animals and humans and the cause of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19. Nurses are the primary service providers in the health care; nurses who are in close contact with infectious patients need to get their mental health checked and supervised on a regular basis, particularly with regard to stress, anxiety, and suicidal ideation, so that they can provide optimal quality of life and healthy mental health to have good care for patients to assess the impact of the pandemic on mental health status for nurses in Iraq.

MATERIALS AND METHODS

A total of sample study (1000) nurses in Iraq completed an online questionnaire between March and May 2021. Psychological impact was assessed using the depression anxiety stress scale (DASS21).

RESULTS

The study revealed impact COVID-19 on mental health status (anxiety stress) and no impact COVID-19 on mental health status (depression) for nurses was (P value = 0.040 and P value = 0.045, respectively).

CONCLUSION

The impact COVID-19 on mental health status for nurses. Protecting the nursing staff from chronic stress, anxiety, and depression, which constitutes a psychological burden on health during the outbreak of the COVID-19 pandemic, by clarifying the disease and how to prevent it, as well as providing the personal protective equipment to decrease stress, anxiety, and depression during the pandemic.

Post-traumatic stress disorder symptoms and associated factors in breast cancer patients during the first COVID-19 lockdown in France

Introduction

We aimed to study post-traumatic stress disorder (PTSD) symptoms in breast cancer (BC) patients during the coronavirus disease (COVID-19) pandemic.

Materials and methods

We included BC patients receiving medical treatment during the first COVID-19 lockdown in France. PTSD symptoms were evaluated using the Impact of Event Scale-Revised (IES-R) questionnaire. Quality of life [Functional Assessment of Cancer Therapy-General (FACT-G)], cognitive complaints [Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog)], insomnia [Insomnia Severity Index (ISI)], and psychosocial experiences during lockdown were also evaluated. Multivariable logistic regression was used to identify clinical factors (from medical records) and psychosocial factors (from questionnaires) associated with PTSD symptoms.

Results

Among the 253 included BC patients (mean age: 58), 46% had metastatic cancer and 52% were treated by chemotherapy alone. COVID-19-induced adjustments in medical oncology practices were experienced by 27% of patients (mainly teleconsultations). No case of COVID-19 was reported; 23% of BC patients had PTSD symptoms. Compared to other patients, patients with PTSD symptoms had more fears relative to COVID-19 infection (83 vs. 60%, p = 0.009), had more feeling of isolation (69 vs. 41%, p = 0.003), and had more prescription or increased use of psychotropic drugs (49 vs. 20%, p = 0.001). In the multivariable model adjusted for clinical factors, fears relative to COVID-19 and increased use of psychotropic drugs were independently associated with PTSD symptoms (OR [95% CI] = 3.01 [1.20–8.44] and 3.45 [1.48–8.17], respectively). Besides, patients with PTSD symptoms had poor quality of life (QoL), and more cognitive complaints and insomnia.

Conclusion

Post-traumatic stress disorder symptoms were observed in 23% of BC patients during the first COVID-19 lockdown in France. Psychological supports are needed for patients treated during the COVID-19 pandemic.

Improving the use of patient-reported outcomes among patients receiving radiation therapy during the COVID-19 pandemic

Introduction

The use of Patient-Reported Outcomes (PROs) is an important part of care for patients receiving radiation therapy. Established processes for patients to complete symptom screening using PROs were disrupted by the COVID-19 pandemic. This study reports the implementation of a Radiation Therapist led “champion” model to support the use of PROs during the COVID-19 pandemic.

Methods

Patient charts were audited May 3 to May 22, 2020 to measure the initial impact of the pandemic on weekly completion rates of PROs for patients receiving active radiation treatment. Beginning May 25, 2020, two Radiation Therapists acted as champions to promote the use of PROs among patients and staff. Weekly completion rates of PROs were monitored from May 25, 2020 to May 28, 2021. The type of Patient Reported Outcome Measure (PROM) utilized and treatment intent was also recorded.

Results

After implementing the champion model, the weekly completion of PROs increased to an average of 47.0 ± 11.7 (47.5 ± 12.6%) from the initial baseline average of 8.7 ± 1.5 (9.4 ± 2.1%). For PROs completed, the distribution of PROMs was an average of 37.2 ± 9.6 (47.7 ± 12.7%) and 9.8 ± 3.5 (47.0 ± 16.9%) for the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the Expanded Prostate Cancer Index Composite (EPIC) respectively. An average of 5.1 ± 2.9 (26.3 ± 12.7%) and 41.9 ± 10.1 (52.4 ± 14.1%) was recorded for palliative and curative intent respectively.

Discussion

An increased number of PROs were completed after implementing the Radiation Therapist led champion model. Patients receiving a radical course of treatment more frequently completed PROs, which in part reflects the longer treatment courses with increased opportunity for PROs to be completed.

Conclusion

The Radiation Therapist led champion model supported ongoing monitoring and completion of PROs during the COVID-19 pandemic and has now been integrated into the department's standard clinical practice.

Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study

PURPOSE

Several studies have reported sleep disturbances during the COVID-19 virus pandemic. Little data exist about the impact of the pandemic on sleep and mental health among older women with breast cancer. We sought to examine whether women with and without breast cancer who experienced new sleep problems during the pandemic had worsening depression and anxiety.

METHODS

Breast cancer survivors aged ≥60 years with a history of nonmetastatic breast cancer (n = 242) and frequency-matched noncancer controls (n = 158) active in a longitudinal cohort study completed a COVID-19 virus pandemic survey from May to September 2020 (response rate 83%). Incident sleep disturbance was measured using the restless sleep item from the Center for Epidemiological Studies-Depression Scale (CES-D). CES-D score (minus the sleep item) captured depressive symptoms; the State-Anxiety subscale of the State Trait Anxiety Inventory measured anxiety symptoms. Multivariable linear regression models examined how the development of sleep disturbance affected changes in depressive or anxiety symptoms from the most recent prepandemic survey to the pandemic survey, controlling for covariates.

RESULTS

The prevalence of sleep disturbance during the pandemic was 22.3%, with incident sleep disturbance in 10% and 13.5% of survivors and controls, respectively. Depressive and anxiety symptoms significantly increased during the pandemic among women with incident sleep disturbance (vs. no disturbance) (β = 8.16, p < 0.01 and β = 6.14, p < 0.01, respectively), but there were no survivor-control differences in the effect.

CONCLUSION

Development of sleep disturbances during the COVID-19 virus pandemic may negatively affect older women's mental health, but breast cancer survivors diagnosed with the nonmetastatic disease had similar experiences as women without cancer.

Quality of Life and Its Associated Factors Among Cancer Patients Receiving Chemotherapy at Oncology Hospitals in Vietnam After the Third Wave of the COVID-19 Pandemic

Purpose

This study aimed to evaluate the health-related quality of life (HRQOL) of cancer patients receiving chemotherapy and identify associated factors affecting the HRQOL after the third wave of the COVID-19 pandemic in Vietnam.

Patients and Methods

Patients with solid cancers receiving chemotherapy at two oncology hospitals in Vietnam during April and May 2021 were included. The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3 was used to measure the HRQOL. Three questions were asked to explore patients’ concern levels about contracting COVID-19, delaying chemotherapy, or not controlling cancer well. One question was used to explore whether patients were concerned about cancer progression or COVID-19 infection more, or equally, or had no concern about both. Multiple regression models were conducted to examine factors associated with the global health status (GHS) score.

Results

Of 270 included patients, mean (Standard deviation [SD]) GHS was 56.7 (20.8). Among the functional statuses, social functioning (SF) had the lowest score of 63.6 (29.2). The symptoms with the highest means were insomnia and fatigue, obtaining the score of 38.5 (31.7) and 37.3 (29.2), respectively. The mean of financial difficulties was 54.1 (32.2). In univariate analysis, high concerns about contracting COVID-19, delaying chemotherapy, not controlling cancer well, or more concern about either cancer or COVID-19 over the other were associated with worse GHS, physical functioning, emotional functioning, and SF. In multivariate analysis, those concerns and no income were significantly related to lower GHS scores besides the non-modifiable factors, such as female gender and some cancer types.

Conclusion

Patients at the high concern levels, or with more concern about either cancer or COVID-19 over the other had poorer HRQOL. Interventions to address the concerns are required to improve their HRQOL, particularly for women, those without income, or with some specific cancers.

The prevalence of psychological disorders among cancer patients during the COVID-19 pandemic A meta-analysis

Purpose

We aimed to assess the prevalence rate (PR) of depression, anxiety, posttraumatic stress disorder (PTSD), insomnia, distress, and fear of cancer progression/recurrence among patients with cancer during the COVID‐19 pandemic.

Methods

Studies that reported the PR of six psychological disorders among cancer patients during the COVID‐19 pandemic were searched in PubMed, Embase, PsycINFO, and Web of Science databases, from January 2020 up to 31 January 2022. Meta‐analysis results were merged using PR and 95% confidence intervals, and heterogeneity among studies was evaluated using I² and Cochran's Q test. Publication bias was examined using funnel plots and Egger's tests. All data analyses were performed using Stata14.0 software.

Results

Forty studies with 27,590 participants were included. Pooled results showed that the PR of clinically significant depression, anxiety, PTSD, distress, insomnia, and fear of cancer progression/recurrence among cancer patients were 32.5%, 31.3%, 28.2%, 53.9%, 23.2%, and 67.4%, respectively. Subgroup analysis revealed that patients with head and neck cancer had the highest PR of clinically significant depression (74.6%) and anxiety (92.3%) symptoms. Stratified analysis revealed that patients with higher education levels had higher levels of clinically significant depression (37.2%). A higher level of clinically significant PTSD was observed in employed patients (47.4%) or female with cancer (27.9%).

Conclusion

This meta‐analysis evaluated the psychological disorders of cancer patients during the COVID‐19 outbreak. Therefore, it is necessary to develop psychological interventions to improve the mental health of cancer patients during the pandemic.

The AAHKS Clinical Research Award: Are Minimum Two-Year Patient-Reported Outcome Measures Necessary for Accurate Assessment of Patient Outcomes After Primary Total Knee Arthroplasty?

BACKGROUND

The two-year minimum follow-up after total knee arthroplasty (TKA) required by most academic journals is based on implant survivorship studies rather than patient-reported outcome measures (PROMs). Additionally, the COVID-19 pandemic placed an unprecedented burden on patients and staff and halted asymptomatic surveillance clinic visits to minimize exposure. The purpose of this study was to determine if clinically meaningful differences were observed in PROMs beyond one year after TKA.

METHODS

A retrospective review was performed on prospectively collected PROMs after 1093 primary TKAs at a suburban academic center. PROMs related to pain, function, activity level, and satisfaction were compared by subsequent follow-up intervals preoperatively, at 4 months, 1 year, and minimum 2 years using paired data analysis techniques.

RESULTS

Pain with level walking and while climbing stairs improved from preoperative levels to 4-month, 1-year, and minimum 2-year follow-up. The University of California Los Angeles activity level and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved over the same intervals. Patient satisfaction improved over postoperative follow-up intervals (84.0%, 87.3%, and 90.9%). While PROMs improved with statistical and clinical significance preoperatively to 4-month to 1-year follow-up, improvements from 1-year to minimum 2-year follow-up were small and did not reach minimum clinically important differences for nearly all PROMs, demonstrating significant overlap of the 95% confidence intervals.

CONCLUSION

While long-term follow-up after TKA remains important for implant survivorship, it appears that one-year PROMs are as clinically reliable and meaningful as two-year PROMs. Therefore, it is reasonable to question the currently accepted 2-year minimum follow-up requirement used in peer-reviewed research involving PROMs.

LEVEL OF EVIDENCE

Level III.

Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients

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.

The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

BACKGROUND AND PURPOSE

The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke.

METHODS

This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March-16th May 2018 (pre-COVID-19 pandemic); and 16th March-16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System-29 (PROMIS-29 version 2.0) at 30 days after stroke.

RESULTS

We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001).

CONCLUSION

Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health.

Psychosocial Implications of COVID-19 on Head and Neck Cancer

The COVID-19 pandemic has fundamentally changed healthcare access, delivery, and treatment paradigms throughout oncology. Patients with head and neck cancer comprise an especially vulnerable population due to the nature of their disease and the transmission mechanism of the SARS-CoV-2 virus. The consequences of triage decisions and delays in care have serious psychosocial implications for patients. The development of structured psychosocial support programs, coupled with clear and consistent communication from treating physicians, can help mitigate perceptions of abandonment and distress that may accompany delays in care. As the unpredictability of the pandemic’s course continues to burden both providers and patients, we must be proactive in addressing the psychosocial implications of these delays in care.

The impact of the COVID-19 pandemic on the quality of life of laryngectomized patients

Introduction: Quality of life is a state of complete physical, mental and social well-being. Due to the COVID-19 pandemic, which led to changes in the daily routine, there was a change in the psychosocial functioning of individuals. Given that laryngectomized patients belong to a vulnerable group that requires psychological support after surgery, specific epidemiological measures during the COVID-19 pandemic could only further increase the fear and reluctance that is especially pronounced after surgery. Aim: The aim of this study was to investigate whether there was a link between the quality of life of laryngectomized patients and the COVID-19 pandemic. Method: The literature review was performed through the Google Scholar Advanced Search search engine and the Consortium of Libraries of Serbia for Unified Acqusition - KoBSON. Results: The first wave of the COVID-19 pandemic significantly disrupted the emotional well-being of patients with head and neck cancer. These patients became even more anxious due to the high mortality from the COVID-19 viral infection, hospital occupancy and missed therapeutic examinations. The need for togetherness, impaired concentration and attention, irritability and fear that family members might suffer from a deadly disease were the most common behavioral problems identified during the COVID-19 pandemic. Conclusion: The psychological burden associated with the direct and indirect effects of the COVID-19 pandemic should not be overlooked, given the fact that laryngectomized patients have twice the risk of suicide compared to patients who have undergone other types of cancer. Assessing the quality of life in laryngectomized patients is very important because it enables the timely identification of mental disorders and suggests the necessary support measures.

The effects of the COVID-19 pandemic on psychological stress in breast cancer patients

Background

The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels pre-COVID-19 pandemic.

Methods

Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network® (NCCN®) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23.

Results

Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms.

Conclusions

This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created “COVID-19 pandemic questionnaire” could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support.

Trial registration

DRKS-ID: DRKS00022507.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-09012-y.

Patient Perceptions of Changes in Breast Cancer Care and Well-Being During COVID-19: A Mixed Methods Study

Background

Widespread healthcare restructuring due to the COVID-19 pandemic led to modifications in the timing and delivery of care for breast cancer patients. Our study explores patient concerns relating to COVID-19, breast cancer, and changes to breast cancer care.

Patients and Methods

Breast cancer patients who presented for surgical consultation at an academic, multidisciplinary clinic completed the electronically distributed validated COVID-19 Impact and Healthcare Related Quality of Life questionnaire between August 2020 and February 2021. This questionnaire uses Likert score responses to assess COVID-specific concerns within domains, including distress and financial hardship. Scale scores were determined by averaging items within each domain, and scores > 2 indicated greater disruption. Semistructured interviews were conducted with patients who indicated interest in participating in the questionnaire.

Results

Of 381 patients recruited, 133 patients completed the questionnaire and 20 patients completed interviews. Sixty-three percent of survey participants reported attending a telemedicine appointment for their cancer care, and the majority (67%) were satisfied with their experience. Half of the participants (50%) reported fear about how the COVID-19 pandemic will impact their cancer care or recovery, and 66% reported anxiety about contracting COVID-19. Twenty-two percent of participants reported decreased income due to COVID-19. Patient interviews revealed tangible changes to care and provided in-depth information on the advantages and disadvantages of telehealth.

Conclusions

Breast cancer patients report anxiety about COVID-19 infection and potential care modifications. Our study identifies impacts on patients’ care and quality of life. Further investigation will inform interventions to improve psychosocial outcomes for patients and the telehealth experience.

Supplementary Information

The online version contains supplementary material available at 10.1245/s10434-021-11209-1.

The impact of the COVID-19 pandemic on perceived access to health care and preferences for health care provision in individuals (being) treated for breast cancer

PURPOSE

To evaluate perceived access to health care and preferences for health care provision among patients (being) treated for breast cancer during the COVID-19 pandemic.

METHODS

Longitudinal study within the prospective, multicenter UMBRELLA cohort of patients (being) treated for breast cancer. All cohort participants enrolled in UMBRELLA between October 2013 and November 2020 were sent a COVID-19-specific survey during the first and second wave of the COVID-19 pandemic, i.e., April 2020 and November 2020, respectively.

RESULTS

In total, 1106 (69.3%) and 822 (50.9%) cohort participants completed the survey in the first and second wave, respectively. The proportion of patients experiencing that their treatment or follow-up care was affected due to COVID-19 decreased from 28.4% (n = 198) in April 2020 to 14.8% (n = 103) in November 2020. Throughout the pandemic, one or more hospital consultations were postponed in 10.0% (n = 82) of all patients and changed into a teleconsultation in 23.1% (n = 190). The proportion of patients who experienced a higher threshold to contact their general practitioner due to COVID-19 decreased from 29.9% (n = 204) in the first wave to 20.8% (n = 145) in the second wave. In-person consultations remained most preferred in 35.2% (n = 289) of all patients. Nearly half of all patients (48.3%, n = 396) indicated that telehealth would be a useful alternative for in-person consultations in future.

CONCLUSION

Perceived access to health care has improved substantially throughout the pandemic. Digital care is well received by patients (being) treated for breast cancer.

The Utilization and Benefits of Telehealth Services by Health Care Professionals Managing Breast Cancer Patients during the COVID-19 Pandemic

Telehealth is the delivery of many health care services and technologies to individuals at different geographical areas and is categorized as asynchronously or synchronously. The coronavirus disease 2019 (COVID-19) pandemic has caused major disruptions in health care delivery to breast cancer (BCa) patients and there is increasing demand for telehealth services. Globally, telehealth has become an essential means of communication between patient and health care provider. The application of telehealth to the treatment of BCa patients is evolving and increasingly research has demonstrated its feasibility and effectiveness in improving clinical, psychological and social outcomes. Two areas of telehealth that have significantly grown in the past decade and particularly since the beginning of the COVID-19 pandemic are telerehabilitation and teleoncology. These two technological systems provide opportunities at every stage of the cancer care continuum for BCa patients. We conducted a literature review that examined the use of telehealth services via its various modes of delivery among BCa patients particularly in areas of screening, diagnosis, treatment modalities, as well as satisfaction among patients and health care professionals. The advantages of telehealth models of service and delivery challenges to patients in remote areas are discussed.

Patient-Reported Outcomes following Genetic Testing for Familial Hypercholesterolemia, Breast and Ovarian Cancer Syndrome, and Lynch Syndrome: A Systematic Review

Background: Patient-reported outcomes (PROs) and PRO measures (PROMs) are real-world evidence that can help capture patient experiences and perspectives regarding a clinical intervention such as genetic testing. Objective: To identify and capture methods and qualitative PRO themes among studies reporting PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Methods: A systematic review was conducted via PubMed/MEDLINE, EMBASE, and Yale University’s TRIP Medical Databases on articles published by April 2021. Results: We identified 24 studies published between 1996 and 2021 representing 4279 participants that reported PROs following genetic testing for FH, breast and ovarian cancer syndrome, and Lynch syndrome. Studies collected and reported PROs from validated PROM instruments (n = 12; 50%), validated surveys (n = 7; 26%), and interviews (n = 10; 42%). PRO themes ranged across all collection methods (e.g., psychological, knowledge, coping and satisfaction, concern about stigma/discrimination, etc.). Conclusions: Important gaps identified include (1) most studies (n = 18; 75%) reported PROs following genetic testing for breast and ovarian cancer, and (2) populations reporting PROs overall were largely of White/Caucasian/Northern European/Anglo-Saxon descent. We offer recommendations and describe real-world implications for the field moving forward.

Psychosocial Impact of Cancer Care Disruptions in Women With Breast Cancer During the COVID-19 Pandemic

Background: The COVID-19 pandemic caused significant disruptions in cancer care, and preliminary research suggests that these disruptions are associated with increased levels of psychosocial distress among cancer survivors. The purpose of this study was to offer a descriptive report of the psychosocial functioning, perceived risk and fear of cancer progression, and COVID-19 pandemic impact and experiences in a unique, high-risk patient cohort: breast cancer survivors whose cancer treatment was delayed and/or changed due to the COVID-19 pandemic. Methods: This cross-sectional study included 50 women with dual carcinoma in situ, lobular carcinoma in situ, or invasive breast cancer whose cancer surgery was postponed due to the pandemic. As they awaited delayed surgery or shortly after they received delayed surgery, participants completed questionnaires on psychosocial functioning (depression, anxiety, sleep, and quality of life), their perceived risk and fear of cancer progression, patient-provider communication about disruptions in their care, personal impact of the pandemic, worry/threat about COVID-19, and COVID-19 symptoms/diagnoses. Descriptive statistics and bivariate correlations were computed among continuous study variables. Independent samples t-tests explored group differences in psychosocial functioning between survivors who were still awaiting delayed surgery and those who had recently received it. Results: Overall, the sample denied that the pandemic seriously negatively impacted their finances or resource access and reported low-to-moderate levels of psychosocial distress and fear about COVID-19. Twenty-six percent had clinically significant levels of fear of cancer progression, with levels comparable to other recent work. About a third were still awaiting delayed cancer surgery and this group reported lower satisfaction with communication from oncology providers but overall did not seem to report more psychosocial difficulties than those who already had surgery. Conclusion: Shortly before or after primary breast cancer surgery that was delayed due to the COVID-19 pandemic, this sample of survivors appears to be generally managing well psychosocially. However, many psychosocial difficulties (e.g., fear of cancer recurrence/progression) typically have an onset after the completion of treatment, therefore, research should continue to follow this cohort of cancer survivors as the pandemic's direct impact on their care likely increases their risk for these difficulties later in survivorship.