Cancer in the Shadow of COVID: Early-Stage Breast and Prostate Cancer Patient Perspectives on Surgical Delays Due to COVID-19

Abstract

Background During the height of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries, including oncologic surgeries, were delayed. Little prospective data existed to guide practice, and professional surgical societies issued recommendations grounded mainly in common sense and expert consensus, such as medical therapy for early-stage breast and prostate cancer patients. To understand the patient experience of delay in cancer surgery during the pandemic, we interviewed breast and prostate cancer patients whose surgeries were delayed due to the pandemic. Patients and Methods Patients with early-stage breast or prostate cancer who suffered surgical postponement at Brigham and Women’s Hospital (BWH) were invited to participate. Semi-structured telephone interviews were conducted with 21 breast and prostate cancer patients. Interviews were transcribed, and qualitative analysis using ground-theory approach was performed. Results Most patients reported significant distress due to cancer and COVID. Key themes that emerged included the lack of surprise and acceptance of the surgical delays but endorsed persistent cancer- and delay-related worries. Satisfaction with patient–physician communication and the availability of a delay strategy were key factors in patients’ acceptance of the situation; perceived lack of communication prompted a few patients to seek care elsewhere. Discussion The clinical effect of delay in cancer surgery will take years to fully understand, but there are immediate steps that can be taken to improve the patient experience of delays in care, including elicitation of individual patient perspectives and ongoing communication. More work is needed to understand the wider experiences of patients, especially minority, socioeconomically disadvantaged, and uninsured patients, who encounter delays in oncologic care. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10319-0.

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

“…People with cancer often experience difficult emotions and face multiple uncertainties, such as treatment choices, treatment effectiveness, and disease recurrence, all of which have been magnified during the COVID-19 pandemic. The psychological stress associated with risk of COVID-19 infection 5 , 7 , delays and disruptions in cancer care 10 , 13 , and isolation from friends and family 11 , 48 have exacerbated preexisting distress among cancer patients. Such worry and uncertainty can lead to treatment burden, poorer symptom management, and poorer health-related quality of life 4 , 54 .…”

“…If not properly managed, this distress leads to treatment burden, such as poorer functioning and well-being associated with treatment and self-care activities [1] ; poorer symptom management; and poorer health-related quality of life 2 , 3 , 4 . The COVID-19 pandemic adds additional psychological burden as cancer patients worry about risk of COVID-19 infection and serious disease 5 , 6 , 7 , 8 , social isolation, loss of social support 9 , 10 , 11 , along with delays, disruptions, and postponement of needed procedures and treatment 10 , 12 , 13 , 14 .…”

“…For example, a recent study reported that elements of patient-centered communication, specifically empathic and understandable language, buffered the adverse effects of COVID-19 related fear on cancer patients’ hopelessness [43] . In a study with breast cancer patient focus groups, most patients reported significant distress due to cancer and COVID-19, yet satisfaction with patient-physician communication was one of the key factors in patients’ acceptance of their health situation [7] .…”

ASO Author Reflections: How We Convey Empathy, Address Uncertainty, and Share Serious News: Challenges to Remote Surgical Care

“…Both patients and physicians have expressed concern regarding the use of telehealth for sensitive conversations, such as a new cancer diagnosis or complex treatment plan. 1,5 The successful implementation of telehealth tailored to cancer care mandates a new approach to teaching and practicing empathetic communication and establishing the patient-physician bond. There is still a need for best practice recommendations regarding which perioperative visits can be feasibly and successfully completed via telehealth.…”

Communication is the Key to an Improved Patient Experience When it Comes to Surgical Delays

“…Sokas et al offer a glimpse inside the thoughts, feelings, and experiences of 21 early-stage breast and prostate patients who had the misfortune of a cancer diagnosis during the initial stages of the pandemic, with resulting postponement of their surgery. 1 The phone interviews explored the extent and causes of anxiety at a point in the patient journey after diagnosis, and the communication of surgical delay. The study sheds light on the importance of physician–patient communication as a crucial factor in patient experience.…”