Medical Care Disruptions During the First Six-Months of the COVID19 Pandemic: The Experience of Older Breast Cancer Survivors

Purpose.

Older cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group.

Methods.

We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60–98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time.

Results.

There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4–73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09–1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003–1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97–0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99–1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions.

Conclusions.

Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.

Acceptability and Feasibility of a Mindfulness-Based Intervention Program for HCT Cancer Caregivers

High levels of stress have been reported amongst allogeneic HCT cancer caregivers and few treatment programs exist to provide stress management skills to this population. A pilot study was conducted to determine the feasibility and acceptability of a six-session mindfulness-based program designed specifically to meet the needs of allogeneic HCT cancer caregivers. Method: Participants completed questionnaires at baseline, end of treatment, and at a one month follow-up. Feasibility criteria consisted of participant accrual, retention, and homework completion. Measures of acceptability included the Client Satisfaction Questionnaire (CSQ; scale of 1–4 [1 = Poor; 4 = Excellent]) and three questions developed for this study to capture overall usefulness of the program; the usefulness of the program in managing stress; and likelihood of continued usage of mindfulness-based strategies (scale of 1–6 [1 = Not very useful; 6 = Very Useful]). Results: Twenty-one caregivers (mean age 57.95; 79% female) were enrolled and completed baseline questionnaires. Of these, 19 attended at least one treatment session, 15 attended at least 4, and 13 attended all sessions. Thirteen completed the post-treatment questionnaires and 14 completed follow-up questionnaires. Participants reported engaging in at least one mindfulness practice daily on 58% of the days enrolled in the study. Results from the CSQ found the program to be highly satisfactory (M = 3.68; SD = 0.28), with higher scores indicating greater satisfaction. Participants responded positively to questions related to overall usefulness of the program (M = 5.36; SD = 0.93), usefulness of the program to help manage stress (M = 5.14; SD = 0.95), and likelihood of continuation of strategy use in the future (M = 5.50; SD = 1.16). At the one month follow up, 100% of participants endorsed still using some of the skills learned during the program. Discussion: These pilot study results found the mindfulness intervention to be both feasible and acceptable. Limitations include: small sample size, homogenous population, and lack of a control group. Larger, future studies are warranted to determine the efficacy of this intervention in relation to a comparison treatment condition.

Understanding preferences for a mindfulness-based stress management program among caregivers of hematopoietic cell transplant patients

Informal caregivers of allogeneic hematopoietic cell transplant patients experience significant levels of stress throughout the caregiving process. One strategy that has been shown to aid in stress management in other populations is mindfulness. The goal of this study was to understand caregivers' experiences with mindfulness and evaluate their receptiveness to a mindfulness-based stress management program. Data were collected via in-depth phone interviews from 18 caregivers (55% female). Results indicated that about half the sample was familiar with mindfulness and/or had practiced meditation. The majority indicated that they believed a mindfulness program would have been useful for them and that they would have been willing to participate. Most indicated that a program delivered once-weekly for 60 min, during both inpatient and outpatient phases, would be preferable through a combination of in-person and mobile-based delivery. These data provide critical information for the development of future mindfulness-based interventions for this caregiving population.