COVID-19 Outbreak Effects on Job Security and Emotional Functioning Amongst Women Living With Breast Cancer

The financial toxicity of breast cancer: a systematic mapping of the literature and identification of research challenges

BACKGROUND

Breast cancer is one of the most common cancers, increasingly prevalent also among working-age populations. Regardless of age, breast cancer has significant direct and indirect costs on the individuals, families and society. The aim of the research was to provide a comprehensive bibliometric analysis of the financial toxicity of breast cancer, to identify research voids and future research challenges.

MATERIALS AND METHODS

The systematic mapping of literature relied on a multi-method approach, combining bibliometric methods with a standard review/discussion of most important contributions. The analysis employed Bibliometrics in R and VosViewer.

RESULTS

The results highlighted the key authors, journals and research topics in the investigation of the financial toxicity of cancer and stressed the concentration of work around several authors and journals.

CONCLUSIONS

The results also revealed a lack of a comprehensive approach in the study of financial toxicity, as the literature often focuses on one or few selected aspects of financial toxicity. In addition, geographic coverage is uneven and differences in the healthcare systems represent a challenge to straightforward comparisons.

The Impact of the COVID-19 Pandemic on Mental Health and Cognitive Function in Patients With Cancer: A Systematic Literature Review

BACKGROUND

The COVID-19 pandeminc has had widespread impacts, but its specific effects on mental health and cognitive function in patients with cancer remain under-explored.

RECENT FINDINGS

Data from the general population has suggested that mental health problems were frequent during the pandemic, namely during the initial stage of the outbreak. For patients with cancer, a systematic review and meta-analysis of data published until January 2021 also showed elevated prevalence of depression and anxiety, and suggested that anxiety was more frequent than in health workers and healthy controls.

OBJECTIVE

This systematic review aimed to synthesize existing evidence on the impact of the COVID-19 pandemic on mental health and cognitive function in patients with cancer.

METHODS

Studies were identified through systematic search of three electronic bibliographic databases (PubMed, Web of Science, and EBSCOHOST) with adapted search strings. We included only peer-reviewed, nonqualitative, original research papers, published between 2019 and 2022, and reporting on mental health and/or cognition outcomes during the COVID-19 pandemic in adult patients with cancer.

RESULTS

Of 3260 papers identified, 121 full text articles were retrieved and 71 met inclusion criteria. We found that patients with cancer reported high levels of psychological distress, anxiety and depression, as well as cognitive complaints during the pandemic. However, studies were not consistent in identifying these symptoms as effects of the pandemic specific for this population. In fact, longitudinal studies did not find consistent differences between pre- and post-pandemic periods and, globally, patients with cancer did not report increased severity of these mental health symptoms in relation to the general population.

CONCLUSION

Overall, while the COVID-19 pandemic may have raised mental health challenges for patients with cancer, the diagnosis of cancer and associated treatments seemed to remain the main source of concern for these patients.

Biopsychosocial Associates of Psychological Distress and Post-Traumatic Growth among Canadian Cancer Patients during the COVID-19 Pandemic

OBJECTIVE

Understanding both the positive and negative psychological outcomes among cancer patients during the pandemic is critical for planning post-pandemic cancer care. This study (1) examined levels of psychological distress and post-traumatic growth (PTG) among Canadian cancer patients during the COVID-19 pandemic and (2) explored variables that were associated with psychological distress and PTG during the pandemic using a biopsychosocial framework.

METHOD

A cross-section survey was undertaken of patients receiving ongoing care at a regional cancer centre in Ontario, Canada, between February and December 2021. Self-reported questionnaires assessing sociodemographic information, social difficulties, psychological distress (depression, anxiety fear of recurrence, and emotional distress), PTG, illness perceptions, and behavioural responses to the pandemic were administered. Disease-related information was extracted from patient health records.

RESULTS

Prevalences of moderate to severe levels of depression, anxiety, fear of recurrence and emotional distress were reported by 26.0%, 21.2%, 44.2%, and 50.0% of the sample (N = 104), respectively. Approximately 43% of the sample reported experiencing high PTG, and these positive experiences were not associated with levels of distress. Social factors, including social difficulties, being female, lower education, and unemployment status were prominent associative factors of patient distress. Perceptions of the pandemic as threatening, adopting more health safety behaviours, and not being on active treatment also increased patient likelihood to experience severe psychological distress. Younger age and adopting more health safety behaviours increased the likelihood of experiencing high PTG. The discriminatory power of the predictive models was strong, with a C-statistic > 0.80.

CONCLUSIONS

Examining both the positive and negative psychological patient outcomes during the pandemic has highlighted the complex range of coping responses. Interventions that adopt a multi-pronged approach to screen and address social distress, as well as to leverage health safety behaviours, may improve the adjustments in the pandemic aftermath.

Experiences of cognitive training on primary breast cancer survivor's cognitive impairments at work: A longitudinal qualitative study

OBJECTIVES

Cancer-related cognitive impairment (CRCI) is associated with adverse work-related outcomes in women living with a history of primary breast cancer. We explored the perceived impact of receiving adaptive cognitive training (dual n-back training) or active control training (dual 1-back training) on CRCI. Furthermore, we explored the perceived transfer effects of cognitive training on work-related self-management methods for cognitive impairment and work-related outcomes such as career development.

DESIGN

Longitudinal qualitative study.

METHODS

A 'framework' analysis approach was used to analyse semi-structured telephone interviews completed by women with a history of primary breast cancer before training (N = 40), one month (N = 30) and six months (N = 29) post-training.

RESULTS

Four main themes were identified: (1) impact of cognitive impairment at work, (2) perceived impact of cognitive training on impaired cognitive function, (3) perceived effects of training on work-related self-management methods for cognitive impairment and (4) perceived impact on women's career development and progression. Compared to baseline, women who received adaptive dual n-back training reported sustained improvement in multiple cognitive domains including memory and attention up to six months post-training when the follow-up interviews were conducted. Perceived improvements in cognitive function were associated with greater self-confidence and better emotional well-being in work. These improvements were found to lower dependency on self-management methods for cognitive impairment and enhance effectiveness as well as prompt career development or progression for many women. Although some findings of a similar nature were reported in the active control dual 1-back training group the perceived effects were more pronounced and consistent in the dual n-back group.

CONCLUSIONS

Adaptive cognitive training (dual n-back training) improves perceived CRCI experienced by women in the workplace, enhancing their self-confidence and general emotional well-being. These perceived improvements, in turn, can decrease reliance on self-management methods for cognitive impairment and improve work efficiency and contribute to career development and progression.

Relationship between subjective well-being and depressive disorders: Novel findings of cohort variations and demographic heterogeneities

This paper uses a large-scale nationally representative dataset, the Chinese General Social Survey, to examine the relationship between subjective well-being and depressive disorders. Statistical results indicate that higher levels of subjective well-being help decrease perceived depression. Robustness checks are carried out using different types of explanatory and dependent variables, various regression models, penalized machine learning methods, instrumental variable approaches, and placebo tests, all of which lend further credence to the above findings. Based on it, heterogeneities in the relationship between subjective well-being and self-rated mental disorders are explored. In respect of variations in age cohorts, it is found that the absolute values of happiness's estimated coefficients are smaller in the 20-30 and 30-40 age groups, while that in the 40-50 age group increase substantially. In older cohorts, the estimates remain at higher levels while fluctuating to some degree. Furthermore, the significantly negative interaction between happiness and age proves that age amplifies subjective well-being's effect on perceived depressive disorders. With age increasing, the impact of happiness on reducing perceived depression tends to be stronger. Therefore, for older people, subjective well-being plays a more important role in suppressing self-rated depression. Heterogeneities of the relationship between happiness and perceived depressive disorders in subgroups with different demographic characteristics are also investigated. It is found that the negative correlation between subjective well-being and self-rated depression is stronger among those with higher educational levels, living in urban areas, being members of the Communist Party of China, having pensions, and owning more housing assets. However, gender, ethnic identity, religious belief, and marital status exert no significant moderating effects.

Experiences of patients with cancer and their relatives confronted with COVID-19 related delay or change in care: A qualitative study

AIMS

To provide in-depth insight into how patients and their relatives experienced change or delay in cancer treatment and care due to COVID-19.

DESIGN

A qualitative study including semi-structured interviews with patients with cancer and their relatives.

METHODS

Between July and October 2020, 42 patients who were confronted with a change or delay in cancer treatment or care, and 11 relatives were interviewed. Data collection and analysis were performed according to the most important methods of grounded theory, including iterative data collection and analysis, theoretical sampling, constant comparative analysis and theoretical sensitivity.

RESULTS

This study shows that patients with cancer and relatives experienced paradoxical feelings when confronted with change or delay in treatment or care due to COVID-19. Patients and relatives felt relieved (e.g. less risk of infection), but were also concerned and anxious (e.g. fear for progression, fear for more side effects). Due to these ambivalent feelings, it was difficult for patients and relatives to cope with the change or delay in treatment or care, both when this was decided by the physician and by themselves. In combination with the general impact of COVID-19 on their daily lives, the change or delay led to additional distress. The interviews showed that exploring the meaning of change or delay of care for patients and their relatives and discussing what would help them might prevent or relieve distress.

CONCLUSION

The findings of our study show that COVID-19 and the associated delay or changes in cancer treatment and care had a major impact on the well-being of patients and their relatives. Person-oriented care is even more important during (emergency) situations in which care might be changed or delayed.

Crosstalk between Depression and Breast Cancer via Hepatic Epoxide Metabolism: A Central Comorbidity Mechanism

Breast cancer (BC) is a serious global challenge, and depression is one of the risk factors and comorbidities of BC. Recently, the research on the comorbidity of BC and depression has focused on the dysfunction of the hypothalamic–pituitary–adrenal axis and the persistent stimulation of the inflammatory response. However, the further mechanisms for comorbidity remain unclear. Epoxide metabolism has been shown to have a regulatory function in the comorbid mechanism with scattered reports. Hence, this article reviews the role of epoxide metabolism in depression and BC. The comprehensive review discloses the imbalance in epoxide metabolism and its downstream effect shared by BC and depression, including overexpression of inflammation, upregulation of toxic diols, and disturbed lipid metabolism. These downstream effects are mainly involved in the construction of the breast malignancy microenvironment through liver regulation. This finding provides new clues on the mechanism of BC and depression comorbidity, suggesting in particular a potential relationship between the liver and BC, and provides potential evidence of comorbidity for subsequent studies on the pathological mechanism.

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 psychosocial and emotional experiences of cancer patients during the COVID-19 pandemic: A systematic review

BACKGROUND

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Global social lockdowns were instigated to reduce spread and prevent health-services from becoming overwhelmed. People having treatment for cancer are known to have heightened psychological/emotional burden. The combined impact of managing pandemic regulations alongside this may present additional burden. The purpose of this systematic review is to examine current evidence of the psychological and emotional impact of COVID-19 on people with cancer, early in the pandemic.

METHODS

Five electronic databases were searched (Embase, Global Health, HMIC, PsychINFO, CINAHL) from September 2019 to October 2021. Qualitative, quantitative and mixed-method primary research studies exploring emotional and psychological impacts of COVID-19 on cancer patients, limited to English language, were included. Quality appraisal was conducted using the MMAT.

RESULTS

Fifty-one papers, with 27,356 people from 21 countries treated for cancer, were included. 43 studies were quantitative with a survey method approach, six studies qualitative and four used a mixed methods design. MMAT score was mostly two or three. Four themes were identified: Emotional aspects and Quality of Life; Psychosocial aspects; Impact of COVID-19 on self; Impact of COVID-19 on cancer, with themes overlapping.

CONCLUSION

Whilst emotional/psychological impacts such as anxiety, isolation, employment fears, and uncertainty about the future were potentially universal concerns early in the pandemic, they may have been particularly acute for people living with cancer and represent complex, overlapping factors. As COVID-19 continues to impact health-services and society, it is important to focus on any ongoing impact to the experience of cancer patients. Most of the studies reviewed used tools that do not provide deeper understanding of how and why emotional states of people with cancer were affected. Further qualitative work may reveal patterns of what was unique to cancer patients during the pandemic, compared to general populations.

Impact of COVID-19 and Consortium Factors on Mental Health: Role of Emotional Labor Strategies in Achieving Sustainable Development Goals

The COVID-19 pandemic that began in 2019 has created an acute fear of economic crisis, and people have experienced the state of perceived job insecurity. Several measures were taken to control this deadly pandemic, but it still affected the majority of global operational activities. This study addresses the United Nation's Sustainable Development Goal (SDG) number 8 that relates to decent work and economic growth. This quantitative study examines the impact of fear associated with economic crisis and perceived job insecurity on mental health with the moderating effect of surface and deep acting. Surface acting is displaying fake emotions, and deep acting is modifying inner feelings according to the required emotions. This study used sample data from private-sector employees and applied SmartPLS for structural model assessment. As many organizations took more challenging decisions to sustain their business operations, the study therefore analyzes the impact of the pandemic on private sector employees. The two main findings of the study are: (i) surface acting moderates the relationships of fear of economic crisis and perceived job insecurity with mental health and declines the impact of both on mental health, (ii) while deep acting negatively moderates the relationships of fear of economic crisis and perceived job insecurity with mental health and improved mental health even in the presence of both. The study highlighted the importance of deep acting at workplaces to sustain employees' mental and psychological stability. Organizations could introduce emotional labor strategies and strengthen the mental health of their employees against the underlying fear of economic crisis and perceived job insecurity.

Performance of Academic Staff during COVID-19 Pandemic-Induced Work Transformations: An IPO Model for Stress Management

The COVID-19 pandemic has adversely affected all spheres of services-related business, including the higher education sector. As a pre-emptive measure, almost all traditional educational institutions have been transformed into virtual organizations. This pandemic-induced work transition has created stress among academic staff and has hampered their performance. The present study aims to examine the impact of leadership behaviors, e-training, and employment security on the stress management process, consequently improving employee performance during and after the pandemic. Based on the IPO (input–process–output) model, this study examines the effect of leadership behavior, e-training, and employment security on teaching staff’s tasks and adaptive and contextual performance, mediated by stress management. To test the conceptual model, data were collected from the teaching staff of Malaysian universities. The structural equation modeling technique was used for data analysis, while bootstrapping with the maximum likelihood estimator was used to confirm the mediational role of stress management. The study revealed that task- and relation-oriented leadership behavior, e-training, and employment security positively influence stress management and employee performance in virtual organizations. Moreover, stress management acts as a full mediator in the relationship between leadership behavior and employee performance, while partial mediation occurs between e-training, employment security, and employee performance. This study offers valuable insights into the literature by proposing leadership behavior, e-training, and employment security as input in the stress management process to attain the performance output of teaching staff. Higher education institutions should come forward to assist their teaching employees in managing their stress levels for better outcomes.

The Ability to Rest at Home During COVID-19 Symptom Manifestation and Depressive Symptoms: Evidence From Korea

OBJECTIVE

This study investigated the association between ability to rest at home in times of coronavirus disease 2019 (COVID-19) symptom manifestation and depressive symptoms.

METHODS

The 2020 Korea Community Health Survey data were used. The presence of depressive symptoms was determined using the Patient Health Questionnaire-9. The relationship between depressive symptoms and ability to rest at home was examined using logistic regression analysis. Additional analysis was performed on the reasons for the inability to stay at home.

RESULTS

Depressive symptoms were more common in participants who could not rest at home if symptoms manifested (4.1%) than those who could rest at home (2.7%). Participants who could not rest at home (OR 1.53, 95% CI 1.34-1.74) were more likely to have depressive symptoms, particularly when they had to report to work (OR 1.50, 95% CI 1.30-1.74) or purchase daily necessities (OR 2.40, 95% CI 1.15-5.03).

CONCLUSION

Inability to rest at home in the case of COVID-19 symptom manifestation was associated with depressive symptoms. The findings suggest the need to address the identified vulnerable groups to mitigate the mental health consequences of the pandemic.

Mental health status of informal waste workers during the COVID-19 pandemic in Bangladesh

The deadliest coronavirus disease 2019 (COVID-19) is taking thousands of lives worldwide and presents an extraordinary challenge to mental resilience. This study assesses mental health status during the COVID-19 pandemic and its associated factors among informal waste workers in Bangladesh. A cross-sectional survey was conducted in June 2020 among 176 informal waste workers selected from nine municipalities and one city corporation in Bangladesh. General Health Questionnaire (GHQ-12) was used to assess respondents’ mental health. The study found that 80.6% of the individuals were suffering from psychological distress; 67.6% reported anxiety and depression, 92.6% reported social dysfunction, and 19.9% reported loss of confidence. The likelihood of psychological distress (Risk ratio [RR]: 1.23, 95% confidence interval [CI]: 1.02–1.48) was significantly higher for female than male. Multiple COVID-19 symptoms of the family members (RR: 1.20, 95% CI: 1.03–1.41), unawareness about COVID-19 infected neighbor (RR: 1.21, 95% CI: 1.04–1.41), income reduction (RR: 1.60, 95% CI: 1.06–2.41) and daily household meal reduction (RR: 1.34; 95% CI: 1.03–1.73) were also found to be associated with psychological distress. These identified factors should be considered in policy-making and support programs for the informal waste workers to manage the pandemic situation as well as combating COVID-19 related psychological challenges.

Emotional Distress in Cancer Patients During the First Wave of the COVID-19 Pandemic

Background: The COVID-19 pandemic has caused mental health problems worldwide. The psychopathological implications of COVID-19 in cancer patients have rarely been addressed. Considering the increased vulnerability of oncology patients, this issue needs to be addressed to improve the long-term mental health status of these patients. Methods: We conducted a prospective study in outpatients under active cancer treatment during the first wave of the COVID-19 pandemic. A semi-structured 24-question survey was designed to measure baseline sociodemographic, psychosocial and COVID-19 exposure characteristics. The Hospital Anxiety and Depression Scale was used to measure psychological symptoms. A descriptive and analytical univariate analysis of the variables studied was performed. We used the Z-score to compare different populations (experimental and historical control cohort). Results: 104 patients were included, the majority of which were women (64.4%), were above 65 years of age (57.7%), had either lung and breast cancer (56.7%), had advanced disease (64%) and were undergoing chemotherapy (63.5%). 51% of them expressed greater fear of cancer than of COVID-19 infection or both. In relation to HADS, 52.8% of emotional distress, 42.3% of anxiety and 58.6% of depression rates were detected. The main factors related with higher rates of psychological symptomatology were history of previous psychotropic drug consumption and the adoption of additional infection prevention measures because they considered themselves at risk of severe COVID-19 infection (p = 0.008; p = 0.003 for emotional distress, p = 0.026; p = 0.004 for anxiety, and p = 0.013; p = 0.008 for depression). Tumor type, stage, oncologic treatment or rescheduling of cancer treatments were not related to higher levels of psychological symptomatology. Comparison of our results with another population of similar characteristics was not significant (Z score = -1.88; p = 0.060). Conclusions: We detected high rates of emotional distress during the first wave of the COVID-19 pandemic among cancer patients in active treatment (52.8%). This was higher and clinically relevant than observed in a comparable population (42.5%), although not significant. Cancer itself is the main factor of concern for cancer patients, above and beyond the emotional distress generated by COVID-19 pandemic.

COVID-19 and patients with cancer: Investigating treatment impact, information sources, and COVID-19-related knowledge, attitudes, and practices

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous strain on public health. Patients with cancer are particularly susceptible to the disease, and their treatment plans have been threatened by public health restrictions designed to contain the spread.

METHODS

This study examined the effects of the pandemic on cancer patients' psychology, knowledge, attitudes, and practices concerning COVID-19 as well as their perceptions of the impact of COVID-19 on their cancer health care services. A survey was sent to 5800 patients at a cancer center in Toronto, Canada. Descriptive results were summarized. Qualitative feedback was coded and summarized. To examine for potential associations, regression models were tested for the outcomes of patient psychological well-being, knowledge, attitudes, and practices, and they accounted for several demographic, health literacy, and disease variables.

RESULTS

A total of 1631 surveys were completed. Most patients saw their appointments shifted to virtual visits, and for a substantial minority, there was no change. A majority of the patients (62%) expressed fears about contracting the virus. There were no independent predictors of COVID-19-related knowledge. Fears were more pronounced among patients who did not speak English and those who used social media more often. Female participants, those who scored higher on knowledge questions, and those who used cancer center materials were more likely to take preventative measures against infection.

CONCLUSIONS

This study provides a snapshot of the state of cancer patient treatment and the knowledge, attitudes, and practices of patients between the first 2 waves of the pandemic. The study's results can inform our understanding of adaptation to conditions during and after the outbreak.

Psychological Distress Among Cancer Patients During COVID-19 Pandemic in the World: A Systematic Review

Aim: Patients with malignancies, experience high rates of psychological distress. Fear of Corona-infection combined with the interruptions in some treatment programs might affect the psychological health of cancer patients. This review study was conducted to investigate the psychological distress among cancer patients during COVID-19 pandemic to offer system-adapted individual solutions.

Materials and methods: To identify the psychological distress of cancer patients, a comprehensive search was carried out in PubMed, Web of Science, and Scopus. English language and original articles were included in this study. Articles that addressed any psychological distress among cancer patients during COVID-19 pandemic were included.

Results: At first 1,410 articles, were included in the study. After removing duplicate articles and reviewing the title and abstract, 55 articles were selected for the review. The findings of this study revealed COVID-19 greatly affects psychological health of cancer patients. Fear of COVID-19, fear of disease progression, disruption of oncology services, cancer stage, and immunocompromised status were the most common causes of psychological distress in oncology patients which can influence patients' decisions about treatment.

Conclusion: The COVID-19 related anxiety is an expected reaction to the current situation. Although psychological distress affects many people, it can confuse cancer patients to the point that they refuse to continue treatment for the fear of infection and worsening of their condition. Since the end of this pandemic is unknown, this action can endanger the health and prognosis of this group of patients, so it seems that using psychological interventions and intensive counseling in the current situation is one of the main priorities for cancer patients.

Consumer preferences for health insurance, in the wake of covid-19: Ranked features and customer segments

The current study is conceptualized to assess the perception of the general population towards health insurance providers and the policy features, to segment them based on their attitudes. The mixed-method design is used in this study. One fifty health insurance users response were analyzed. The data analysis technique includes focus group discussion, henry garret ranking method, factor analysis and cluster analysis. This study concludes that health insurance providers needs to devise insurance policies incorporating the features of home health, telemedicine and income protection features. The existing users should be offered customization option due to covid-19 to prevent customer switch.

Psychosocial Aspects During the First Wave of COVID-19 Infection in South Africa

Background: In South Africa, as in many countries, the nationwide spread of COVID-19 caused a public health emergency that resulted in the government implementing necessary restrictive measures such as the nationwide lockdown as a way of containing the pandemic. Such restrictive measure, while necessary, can disrupt many aspects of people's lives resulting in unprecedented psychosocial distress. Aim: The present study aims to describe the psychosocial health and situational factors associated with the novel coronavirus (COVID-19) in South Africa during the first wave of infection. Methods: This cross-sectional survey, recruited a total of 203 participants through convenience sampling via online platforms-WhatsApp, Facebook, emails, etc.-during COVID-19 lockdown in the country. Through the snowball technique, participants from across South Africa completed the online survey that assessed socio-demographic information, risk perception, history of mental health, COVID-19-related stress, and fears during the lockdown (first wave). Results: The majority of the participants who completed the survey were young, Black African, and female. Participants reported feelings of stress and anxiety (61.2%); stress about finances (39.5%); and feelings of sadness, anger, and/or frustration (31.6%) during the lockdown. Females compared to males were more likely to perceive COVID-19 as a risk to their household,X ( 20 ) 2 = 45,844, p < 0.001 and community,X ( 20 ) 2 = 40,047, p = 0.005. COVID-19 differentially impacted the mental health of participants with and without mental health diagnosis,X ( 4 ) 2 = 16.596, p = 0.002. Participants with a prior mental health diagnosis reported significant extra stress during lockdown (p < 0.05). Conclusion: The findings may be of significance to assist in the development of targeted psychosocial interventions to help people during and after the pandemic.

Knowledge and Anxiety about COVID-19 in the State of Qatar, and the Middle East and North Africa Region-A Cross Sectional Study

While the coronavirus disease 2019 (COVID-19) pandemic wreaked havoc across the globe, we have witnessed substantial mis- and disinformation regarding various aspects of the disease. We conducted a cross-sectional study using a self-administered questionnaire for the general public (recruited via social media) and healthcare workers (recruited via email) from the State of Qatar, and the Middle East and North Africa region to understand the knowledge of and anxiety levels around COVID-19 (April-June 2020) during the early stage of the pandemic. The final dataset used for the analysis comprised of 1658 questionnaires (53.0% of 3129 received questionnaires; 1337 [80.6%] from the general public survey and 321 [19.4%] from the healthcare survey). Knowledge about COVID-19 was significantly different across the two survey populations, with a much higher proportion of healthcare workers possessing better COVID-19 knowledge than the general public (62.9% vs. 30.0%, p < 0.0001). A reverse effect was observed for anxiety, with a higher proportion of very anxious (or really frightened) respondents among the general public compared to healthcare workers (27.5% vs. 11.5%, p < 0.0001). A higher proportion of the general public tended to overestimate their chance of dying if they become ill with COVID-19, with 251 (18.7%) reporting the chance of dying (once COVID-19 positive) to be ≥25% versus 19 (5.9%) of healthcare workers (p < 0.0001). Good knowledge about COVID-19 was associated with low levels of anxiety. Panic and unfounded anxiety, as well as casual and carefree attitudes, can propel risk taking and mistake-making, thereby increasing vulnerability. It is important that governments, public health agencies, healthcare workers, and civil society organizations keep themselves updated regarding scientific developments and that they relay messages to the community in an honest, transparent, unbiased, and timely manner.

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

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

Depression and Anxiety Among Patients with Cancer During COVID-19 Pandemic: A Systematic Review and Meta-analysis

BACKGROUND

Investigations about the impact and consequences of the COVID-19 infection on the mental health of patients with chronic diseases and those with immunosuppressive conditions are growing. The current study aimed to systematically review and meta-analysis of studies that evaluated the level of depression and anxiety in cancer patients during the COVID-19 pandemic.

METHODS

The PubMed, Scopus and Web of Sciences databases were searched to retrieve potential studies from January 2020 to 3 January 2021. Summary data on frequency and mean of depression and anxiety were extracted. Random-effect meta-analysis was conducted to estimate overall prevalence, mean and standardized mean difference.

RESULTS

Thirty-four studies were included in the systematic review, of them 21 studies included in meta-analysis. Overall depression and anxiety were 0.37 (0.27, 0.47); I² = 99.05%, P value < 0.001 and 0.38 (0.31, 0.46); I² = 99.08%, P value < 0.001, respectively. Compared to controls, cancer patients had higher anxiety level [standard mean difference (SMD 0.25 (95% CI 0.08, 0.42)].

CONCLUSION

Overall, the findings of this study suggest that the prevalence of depression and anxiety among patients with cancer during the COVID-19 pandemic can reach considerable levels, although observed substantial heterogeneity should be considered when interpreting the results.

COVID-19 Pandemic Stressors and Psychological Symptoms in Breast Cancer Patients

BACKGROUND

The current Coronavirus disease 2019 (COVID-19) pandemic is a highly stressful event that may lead to significant psychological symptoms, particularly in cancer patients who are at a greater risk of contracting viruses. This study examined the frequency of stressors experienced in relation to the ongoing coronavirus pandemic and its relationship with psychological symptoms (i.e., anxiety, depression, insomnia, fear of cancer recurrence) in breast cancer patients.

METHODS

Thirty-six women diagnosed with a non-metastatic breast cancer completed the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, the severity subscale of the Fear of Cancer Recurrence Inventory, and the COVID-19 Stressors Questionnaire developed by our research team. Participants either completed the questionnaires during (30.6%) or after (69.4%) their chemotherapy treatment.

RESULTS

Results revealed that most of the participants (63.9%) have experienced at least one stressor related to the COVID-19 pandemic (one: 27.8%, two: 22.2%, three: 11.1%). The most frequently reported stressor was increased responsibilities at home (33.3%). Higher levels of concerns related to the experienced stressors were significantly correlated with higher levels of anxiety, depressive symptoms, insomnia, and fear of cancer recurrence, rs(32) = 0.36 to 0.59, all ps < 0.05.

CONCLUSIONS

Cancer patients experience a significant number of stressors related to the COVID-19 pandemic, which are associated with increased psychological symptoms. These results contribute to a better understanding of the psychological consequences of a global pandemic in the context of cancer and they highlight the need to better support patients during such a challenging time.